Individuals who are dually eligible for Medicare and Medicaid often have multiple chronic conditions, behavioral health issues, and functional needs and frequently receive fragmented, uncoordinated care across both programs. People eligible for both programs include Medicaid beneficiaries who qualify for Medicare after turning 65 years old or individuals under 65 who are eligible based on a permanent disability. This population is both high need and high cost, making up a disproportionate amount of overall Medicare and Medicaid spending.
During the past 10 years, more states have pursued programs that integrate Medicare and Medicaid benefits for dually eligible individuals, with increasing evidence supporting positive health outcomes and efficiencies associated with these models. However, despite recent increases in integrated models, only about 10 percent of dually eligible individuals are currently enrolled in such programs. Health plans, policymakers, and health system leaders interested in more effectively addressing the complex needs of dually eligible individuals can benefit from understanding the evidence on Medicare-Medicaid integration and learning about promising strategies for implementing integrated care program and delivery models.
To support health care stakeholders in advancing greater integration of care for dually eligible individuals, the Better Care Playbook curated a set of resources to help health plans, policymakers, and providers better understand: (1) the needs of this population, focusing on the diverse subsets of dually eligible individuals; (2) the evidence for investing in integrated care; and (3) implementation resources and policy considerations for advancing integrated care models.