Individuals who are dually eligible for Medicaid and Medicare represent about one-third of total costs to the federal government and to states in each program. Dually eligible beneficiaries may experience fragmented care and poor health outcomes when delivery of health services and administration of benefits are not coordinated across the two programs. States and the federal government have been working together to develop and implement a variety of integrated care models that have the potential to improve health outcomes and reduce federal and state spending for this high-cost, high-need population.
This presentation reviews two draft chapters and two draft recommendations for the June 2020 report to Congress. The first chapter provides background information on this diverse population, which includes individuals with complex care needs and unaddressed social determinants of health. It also provides an overview of integrated care models.
The second chapter provides an overview of policy issues the Commission has discussed over the past year related to strengthening and expanding the reach of integrated care programs. The Commission approved both of this chapter’s recommendations as drafted. The first recommendation calls on the Centers for Medicare & Medicaid Services to issue subregulatory guidance to create an exception to the special enrollment period for dually eligible beneficiaries eligible for Medicare-Medicaid plans. The second recommendation calls on Congress to provide additional federal funds to enhance state capacity to develop expertise in Medicare and to implement integrated care models.