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Advancing Medicare-Medicaid Integration through Medicaid Programs: A Policy Roadmap


Approximately 12 million individuals are dually eligible for both Medicare and Medicaid. These dual eligible individuals experience medical, functional, and social needs at higher rates than the Medicare-only or Medicaid-only population. Further, dual eligible individuals are often forced to navigate complex and sometimes conflicting requirements across Medicare and Medicaid, leading to poor outcomes, stress for individuals and their families, and increased system spending. In response, policymakers have sought to integrate the programs, but federal requirements typically fall on Medicare plans such as Dual Eligible Special Needs Plans (D-SNPs). Currently, no federal requirements exist to ensure that Medicaid programs serving dual eligible individuals integrate with Medicare.


With support from Arnold Ventures, ATI Advisory evaluated Medicaid regulations and catalogued opportunities to promote Medicare integration in Medicaid program approvals. We produced a Roadmap that enumerates these opportunities for the Center for Medicaid and CHIP Services (CMCS) to consider, to increase the Medicaid program’s integration with Medicare across two unexplored pathways: managed care programs and underlying home and community-based services (HCBS) approvals.


Using its authority to regulate Medicaid programs, CMS has an opportunity to achieve greater integration of Medicare and Medicaid for all dual eligible individuals, and better serve the nearly half of dual eligible individuals lacking access to meaningfully integrated programs in their county and state of residence.


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