Individuals who are dually eligible for Medicaid and Medicare may experience fragmented care and poor health outcomes when delivery of health services and administration of benefits are not coordinated across the two programs. Over the past two years, MACPAC has been examining how to increase enrollment in integrated models and increase availability of such models across geographic areas. Given the limitations inherent in integrating care across two separate programs, some stakeholders have begun to reconsider how to serve the dually eligible population, exploring how to create a wholly new, unified program that would replace the fragmented system we have today.
Staff presented a draft chapter for the March 2021 report that examines key design considerations that would have to be addressed to establish a unified program. It begins with background on existing integrated care models, then offers specific policy considerations for issues related to eligibility, beneficiary protections and enrollment, benefits, the delivery system and model of care, administration, and financing. As context for that discussion, the chapter draws examples from two existing proposals to create a fully integrated system for dually eligible beneficiaries.