A Pathway to Full Integration of Care for Medicare-Medicaid Beneficiaries

Katherine Hayes
G. William Hoagland
Lisa Harootunian
Eleni Salyers
Kevin Wu
July 2020

Improved integration of Medicare and Medicaid services offers the potential to improve beneficiary experience, outcomes, and well-being – and also has the potential for long-term savings. The Bipartisan Policy Center developed a series of recommendations for states to advance more integrated care, based on promising practices during the last several years. The report identifies three care models that states can choose to achieve full integration: (1) improved Fully Integrated Dually Eligible Special Needs Plans (FIDE-SNPs); (2) Programs of All-Inclusive Care for the Elderly (PACE); and (3) a flexible model building off the managed fee-for-service model implemented in Washington State.

The recommendations in this report propose a framework for integrating services, beginning with a definition for what “full integration” means. It suggests requiring states to provide access to a fully integrated option (with a federal fallback program) for all dually eligible individuals. Recommendations directed at Congress address enrollment and eligibility, incentives for states to integrate care, and improving beneficiary experience. The best practices identified in this report are informative for states looking to advance integration. Critical elements to success are leadership buy-in and ongoing support, beneficiary and provider engagement and active participation, and state capacity and resources.

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