People who are dually eligible for Medicare and Medicaid must navigate two uncoordinated systems of care with different incentives, benefits, provider networks and enrollment processes. As states consider ways that they can address the unique and complex needs of dually eligible beneficiaries, it is important to have key information to help them make the case — both internally and externally — for investing in this work. Drawing on published research as well as interviews with state leaders who have launched this programs, this brief highlights the value of integrated care for state Medicaid agencies.
Integrated care models are associated with promising outcomes for states, including: (1) improved beneficiary experience, health outcomes, and quality of life; (2) increased program efficiencies resulting from aligned financial incentives; and (3) improved Medicaid program administration and management, including through improved access as to Medicare data and more capacity to better manage this high-need, high-cost population. While much of the cost savings related to integrated care models (such as those resulting from reduced acute care utilization) may accrue to Medicare, states also have opportunities to achieve costs savings to Medicaid while addressing the needs of their aging populations and increased demands for long-term services and supports.