Integrating Care for Dually Eligible Beneficiaries: Background and Context

June 2020

Since Medicare and Medicaid are two separate systems that were not designed to work together, people who are dually eligible often experience fragmented care, resulting in worse health outcomes and higher costs. This MACPAC report summarizes the characteristics of dually eligible individuals to better understand the needs of this population, including their pathways to eligibility, demographics, health status, and service use and spending. This report provides a high-level summary of the integrated care models designed, including details on improving coordination and quality of care, and their approach, enrollment, and available evidence of their effectiveness. These models include: (1) the Medicare-Medicaid Plans that operate under Financial Alignment Initiative demonstrations; (2) Medicare Advantage dual eligible special needs plans aligned with managed long-term services and supports, including Highly Integrated Dually Eligible Special Needs Plans and Fully Integrated Dually Eligible Specially Needs Plans; (3) the Financial Alignment Initiative’s managed fee-for-service model; and (4) Program of All-Inclusive Care for the Elderly. This report can support policymakers in gaining a better understanding of dually eligible individuals as well as the policy levers currently available to address the challenges faced by this population.

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