Access to Medicare-Medicaid Products
Dual eligible individuals represent a medically, socially, and often functionally complex population. They tend to be low-income with high-risk for socioeconomic disadvantage and use more healthcare services than the broader Medicare population. And they must navigate a fragmented healthcare system that includes two major programs (Medicare and Medicaid), often with little to no connection between their coverages. CMS, states, and Congress have sought to address this fragmentation for several decades, most recently with the Bipartisan Budget Act of 2018 requiring enhanced integration for dual-eligible special needs plans (D-SNPs) and prior to that, through the Financial Alignment Initiative and Medicare-Medicaid Plans (MMPs).
Through funding from Arnold Ventures, ATI quantified year-over-year changes in access to Medicare-Medicaid integrated products. D-SNP access varies by county, and a dual eligible individual’s access to integrated care depends on the degree of integration of D-SNPs in their county.
We found that approximately half of dual eligible individuals continue not to have access to products currently considered the “gold standard” of integration – FIDE SNPs and MMPs. Policymakers should continue to promote and require integration for dual eligible individuals, including identifying solutions in states and counties that may not have a direct path toward a FIDE-SNP or Financial Alignment program.