More than 10 million Americans are dually eligible for Medicare and Medicaid. This population includes many of the poorest, sickest, and costliest beneficiaries in both programs. Due to program misalignments, however, these beneficiaries often receive fragmented, uncoordinated care. In 2011, the Centers for Medicare & Medicaid Services (CMS) launched the Financial Alignment Initiative to test new models to integrate Medicare and Medicaid—referred to as financial alignment demonstrations or “demonstrations” in each state in which they operate. Through these demonstrations, CMS and states can contract with Medicare-Medicaid Plans (MMPs), which are responsible for managing the full range of covered services for dually eligible beneficiaries.
This report examines the experiences of 14 MMPs that are members of the Association for Community Affiliated Plans (ACAP) and managing demonstrations. On behalf of ACAP, the Center for Health Care Strategies (CHCS) interviewed these plans to identify innovations advanced under the demonstrations, as well as lessons for integrating care for dually eligible individuals. Following is a summary of findings from these interviews that may inform efforts to improve Medicare and Medicaid integration and alignment.View the full article »