A Brief Overview of Key Beneficiary protections in Medicare-Medicaid Integrated Programs
Dual eligible beneficiaries, who are enrolled in both Medicare and Medicaid, typically experience fragmented and misaligned care between the two uncoordinated insurance programs. To combat this fragmentation, States and the Centers for Medicare & Medicaid Services (CMS) developed integrated programs that allow a more seamless experience for dual eligible beneficiaries and offer beneficiary protections. While these protections exist at the program and policy-level, little is known about how they translate into beneficiary experiences.
Arnold Ventures and ATI Advisory analyzed the current protections and consumer engagements that integrated Medicare-Medicaid programs offered to dual eligible beneficiaries. The analysis compared the Traditional Fee-for-Service model, Dual Eligible Special Needs Plans (D-SNPs), Fully-Integrated & Highly-Integrated Dual Eligible Special Needs Plans (FIDE/HIDE SNPs), and Medicare-Medicaid Plans (MMPs). Varied federal policies across programs reveal a continuum of protections for beneficiaries.
While protections exist, it is not clear whether they are sufficient or how they impact individuals. Moving forward, more research is needed to quantify the impact on dual eligible beneficiaries who represent some of the most vulnerable individuals in the Medicare and Medicaid programs. This brief identifies key protections that should be explored in greater detail.