Integrating Care for Dually Eligible Beneficiaries: Policy Issues and Options

June 2020

Many dually eligible individuals receive Medicare and Medicaid benefits that are not coordinated, which can result in fragmented care and poor health outcomes. Only 10 percent of dually eligible individuals are enrolled in integrated care programs. This report details the current landscape of integrated care models, and identifies policy recommendations to increase enrollment in integrated models and promote greater integration in existing programs. 

State opportunities to advance more integrated care include: (1) implementing default enrollment; (2) improving state capacity on Medicare; (3) providing upfront funding for establishing integrated care models; (4) strengthening Medicare-Medicaid plans; (5) maximizing state use of dual eligible special needs plan (D-SNP) contracting authorities; (6) increasing selective contracting with D-SNPs; (7) diminishing the potential for “D-SNP look-alike plans” to negatively affect integrated care programs; and (8) limiting D-SNP enrollment to full benefit dually eligible beneficiaries. These recommendations may support states in setting priorities and identifying strategies to implement these programs.

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