Headline

Tool describes a state policy strategy for improving coordination across Medicare and Medicare for dually eligible individuals.

Context

People who are eligible for both Medicare and Medicaid often experience challenges navigating benefits across these two payment systems. States are increasingly interested in addressing these challenges, particularly as this population tends to have more complex and costly medical conditions in addition to functional and social risk factors. This tool describes a state policy strategy, known as “exclusively aligned enrollment” (EAE), that can increase coordination.

About this Tool

Under EAE, states can require full-benefit dually eligible enrollees in Medicare Dual Eligible Special Needs Plans (D-SNPs) to be enrolled in a Medicaid managed care plan offered by the same parent organization as the D-SNP. This tip sheet describes the benefits of EAE to Medicare-Medicaid enrollees, providers, and states. Additional resources are listed for states to learn more about applying the EAE approach. For example, EAE reduces incentives for health plans to cost-shift across Medicare and Medicaid programs, and can make it easier to access comprehensive data across Medicare and Medicaid services.

Takeaways

State policymakers can use this tool and its related resources when developing and refining D-SNP contracting strategies, including EAE. Stakeholders can use this tool to consider the benefits of EAE in the delivery of care, such as consolidated provider billing.