Integrated care for dually eligible beneficiaries

Dually Eligible Beneficiaries

States are testing several integrated care models that aim to improve care for beneficiaries and reduce costs. For example, better management of care transitions following an acute inpatient hospital admission (paid for by Medicare) for dually eligible beneficiaries who are receiving home- and community-based services (paid for by Medicaid) could help reduce avoidable re-hospitalizations. In recent years, states interested in integrating care for dually eligible beneficiaries have pursued several options, including:

The Bipartisan Budget Act of 2018 (P.L. 115-123) permanently authorized D-SNPs and included provisions to integrate care for dually eligible beneficiaries. The law requires the Centers for Medicare & Medicaid Services to unify appeals and grievances processes for D-SNPs to the extent feasible by 2020 and establishes new requirements for D-SNPs to integrate Medicare and Medicaid benefits after 2021.

For more information on integrated appeals, see the January 2018 Commission meeting presentation, Integrating Appeals Processes for Dually Eligible Beneficiaries.

For information on setting Medicaid capitation rates for integrated care plans, see the March 2013 report to Congress chapter on Issues in Setting Medicaid Capitation Rates for Integrated Care Plans.