Integrating care for the 12.3 million Americans who were dually eligible for Medicaid and Medicare in 2020 has the potential to improve care and reduce federal and state spending. However, only about 1 million full-benefit dually eligible beneficiaries were enrolled in integrated care models in 2020.
States are at different stages of integrating coverage for dually eligible beneficiaries and face a number of barriers to moving forward, including limited resources and lack of Medicare expertise.
In this session, staff presented a draft chapter for the June report to Congress with a recommendation to require all states to develop a strategy to integrate coverage. The strategy should include the following components: integration approach, eligibility and benefits covered, enrollment strategy, beneficiary protections, data analytics, and quality measurement. It should also consider how to promote health equity. The recommendation includes federal financing to support states in developing the strategy.
The Commission voted in favor of the recommendation. The recommendation, as passed, reads:
Congress should authorize the Secretary of the U.S. Department of Health and Human Services to require that all states develop a strategy to integrate Medicaid and Medicare coverage for full-benefit dually eligible beneficiaries within two years with a plan to review and update the strategy, to be specified by the Secretary. The strategy should include the following components – integration approach, eligibility and benefits covered, enrollment strategy, beneficiary protections, data analytics, and quality measurement – and be structured to promote health equity. To support states in developing the strategy, Congress should provide additional federal funding to states to assist with these efforts toward integrating Medicaid and Medicare coverage for full-benefit dually eligible beneficiaries.
