Funder: ADvancing States

Author: Michelle Herman Soper and Alexandra Kruse, Center for Health Care Strategies; and Camille Dobson, ADvancing States

November 2019 | Brief


People who are dually eligible for Medicare and Medicaid must navigate two uncoordinated systems of care with different incentives, benefits, provider networks and enrollment processes. This can be challenging for a population with diverse, but significant medical, behavioral health, functional, and social needs. Integrating the financing and delivery systems for Medicare and Medicaid enrollees offers the potential to improve beneficiary care experience, increase health outcomes, and reduce costs. ADvancing States, in partnership with the Center for Health Care Strategies, is producing a series of briefs to inform the adoption of state strategies that better align Medicare and Medicaid for dually eligible beneficiaries.

“States are increasingly considering ways they can address the unique and complex needs of dually eligible beneficiaries,” said Allison Hamblin, MSPH, CHCS President and CEO. “This brief summarizes key information that can help states make the case − both internally and externally − for investing in this important work.”

This first brief highlights the value of integrated care for state Medicaid agencies from published research and anecdotal information from state leaders who have launched these programs. Promising findings for states considering new integrated care models include: (1) improved beneficiary experience, health outcomes, and quality of life; (2) increased program efficiencies; and (3) improved Medicaid program administration and management.