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Improving Integration for Dually Eligible Beneficiaries: Strategies for State Contracts with Dual Eligible Special Needs Plans

Chapter 6 continues the Commission’s work on integrating care for the 12.3 million individuals who are dually eligible for Medicaid and Medicare. People who are eligible for both programs often experience fragmented care and poor health outcomes because their benefits are not coordinated.

In this chapter, we focus on ways states can use their contracts with Medicare Advantage dual eligible special needs plans (D-SNPs) to promote greater integration and increase enrollment in integrated plans. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA, P.L. 110-275) requires all D-SNPs to have contracts with the states in which they operate, sets minimum integration standards, and gives states the authority to impose additional requirements on D-SNPs. MACPAC identified ways states can exercise their MIPPA authority to improve the integration of Medicaid and Medicare services and to help states implement these strategies.

From: June 2021 Report to Congress on Medicaid and CHIP