Over the last decade, state and federal policymakers have worked to better integrate Medicare and Medicaid benefits, financing, and administrative processes to improve care for the more than 12 million people in the United States who are dually eligible for these programs.

Federal legislation and rulemaking have made it possible for states, health plans, and providers to develop several integrated care models: the Program for All-Inclusive Care for the Elderly, state-based demonstrations under the federal Financial Alignment Initiative, and programs in which Dual Eligible Special Needs Plans are closely aligned with Medicaid managed care plans. But despite federal policy actions and state investments, only about 12 percent of full-benefit dually eligible individuals were enrolled in an integrated care program in 2020.

In this Health Affairs blog post, CHCS’ Nancy Archibald outlines perspectives from state Medicaid officials on the federal policies that have advanced Medicare-Medicaid integration, and areas where they believe additional federal policy actions are needed.