States are testing several integrated care models that aim to improve care for beneficiaries and reduce costs. For example, better management of care transitions following an acute inpatient hospital admission (paid for by Medicare) for dually eligible beneficiaries who are receiving home- and community-based services (paid for by Medicaid) could help reduce avoidable re-hospitalizations. In recent years, states interested in integrating care for dually eligible beneficiaries have pursued several options, including:
- the Financial Alignment Initiative, generally referred to as the duals demonstrations;
- exercising their contracting authority with Medicare Advantage dual eligible special needs plans (D-SNPs), including aligning Medicaid Managed long-term services and supports programs with D-SNPs; and,
- the Program of All-Inclusive Care for the Elderly.
The Bipartisan Budget Act of 2018 (P.L. 115-123) permanently authorized D-SNPs and included provisions to integrate care for dually eligible beneficiaries. The law requires the Centers for Medicare & Medicaid Services to unify appeals and grievances processes for D-SNPs to the extent feasible and establishes new requirements for D-SNPs to integrate Medicaid and Medicare benefits.
For more information on D-SNPs, see MACPAC’s June 2021 report to Congress, Improving Integration for Dually Eligible Beneficiaries: Strategies for State Contracts with Dual Eligible Special Needs Plans.
For information on design considerations for a unified program for the dually eligible population, see MACPAC’s March 2021 report to Congress, Establishing a Unified Program for Dually Eligible Beneficiaries: Design Considerations.
For information on policy issues for integrated care, see MACPAC’s June 2020 report to Congress, Integrating Care for Dually Eligible Beneficiaries: Policy Issues and Options.
For background on integrated care, see MACPAC’s June 2020 report to Congress, Integrating Care for Dually Eligible Beneficiaries: Background and Context.
For information on integrated appeals, see the January 2018 Commission meeting presentation, Integrating Appeals Processes for Dually Eligible Beneficiaries.
For information on evaluations of integrated care, see the Inventory of Evaluations of Integrated Care Programs for Dually Eligible Beneficiaries.
For information on care coordination in integrated care models, see the contractor report, Care Coordination in Integrated Care Programs Serving Dually Eligible Beneficiaries – Health Plan Standards, Challenges and Evolving Approaches.
For information on setting Medicaid capitation rates for integrated care plans, see the March 2013 report to Congress chapter on Issues in Setting Medicaid Capitation Rates for Integrated Care Plans.