A Profile of Medicare-Medicaid Dual Beneficiaries

Program of All-Inclusive Care for the Elderly (PACE) is a capitated health plan that provides comprehensive Medicare and Medicaid covered services to frail, older adults in the community who are eligible for nursing home care. New research from ATI explores the latest enrollment trends and highlights latest opportunities for PACE growth.

Beginning January 1, 2030, Dual Eligible Special Needs Plan (D-SNP) enrollment must be fully aligned with Medicaid plan enrollment, and beneficiaries will no longer be able to stay in their current D-SNP. Building on a previous ATI resource, this brief outlines a transitional strategy for states subject to the impending D-SNP enrollment alignment requirements to consider.

The Kim Frailty Index (KFI) is a validated, peer-reviewed measure of frailty that uses only healthcare claims data to measure frailty with sufficient accuracy for population-level decision making. The CMS Innovation Center is embedding KFI data into its Long-term Enhanced ACO Design (LEAD) Model as one of the factors used to assess whether a beneficiary qualifies as "High Needs."