The federal government and states are testing multiple models of integrated care for dually eligible beneficiaries including: the Financial Alignment Initiative, alignment of managed long-term services and supports programs with dual eligible special needs plans, and fully integrated dual eligible special needs plans. Coordinating care across Medicare and Medicaid benefits is a goal of these programs, as it is expected to improve patient care and reduce costs.
MACPAC contracted with Health Management Associates (HMA) to research care coordination requirements for these three integrated care models. HMA reviewed state contracts to identify requirements for managed care organizations, such as qualifications of care coordinators and care coordinator caseload ratios. HMA also interviewed stakeholders to gain insights on challenges in implementing these standards and what has worked well. HMA found that requirements related to managing care transitions were common in all three models, and challenges include engaging primary care practitioners.