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Integrating Care for Dually Eligible Beneficiaries: Policy Issues and Options

Individuals who are dually eligible for Medicaid and Medicare often experience fragmented care and poor health outcomes due to lack of coordination across the two programs. Integrating care has the potential to improve the health of these individuals and reduce federal and state spending on their care, but as of 2019, only about 10 percent of dually eligible beneficiaries received care through such integrated models.

In this chapter, the Commission makes two modest but important recommendations toward increasing the availability of, and enrollment in, integrated care models. The chapter also lays out the Commission’s concerns about the emergence and growth of dual eligible special needs look-alike plans, traditional Medicare Advantage plans that do not coordinate Medicaid and Medicare benefits but appear to be drawing dually eligible beneficiaries away from integrated care products.

The Commission’s analyses in the June report are the first steps in a multiyear inquiry focusing on a range of policy options that could increase integrated care.

From: June 2020 Report to Congress on Medicaid and CHIP