Behavioral Health

The recently released CY2027 Medicare Advantage and Part D (MAPD) Proposed Rule could meaningfully influence how plans serve dual-eligible individuals. While the rule spans a wide range of operational, quality, and benefit topics, several areas stand out for their potential impact on integration. ATI is unpacking the proposal and implications for plans, states, and other healthcare stakeholders.

On December 1st, CMS introduced the Advancing Chronic Care with Effective, Scalable solutions (ACCESS) Model, a voluntary 10-year model aimed at expanding access to new technology-enabled care for Medicare beneficiaries. The ACCESS model focuses on outcomes and creates opportunities for organizations that use technology and innovative approaches to support patients in preventing and managing chronic conditions to partner with traditional healthcare.

Dual eligible individuals – who are eligible for both Medicare and Medicaid – often receive fragmented, uncoordinated care as these programs were not designed to work together. Dual eligible individuals with additional complex needs, including home- and community-based services (HCBS) and behavioral health needs, can experience added challenges. These briefs focus on opportunities to improve dual eligible individuals’ access to and experience with HCBS and behavioral health services, and provide suggestions for policymakers to strengthen the programs, including integrated care programs, that serve this population.

Brian Fuller, Managing Director of ATI Advisory’s Value-Based Care Design and Delivery Practice, and Johanna Barraza-Cannon, Director in ATI’s State Program & Policy Practice, reviewed and shared early observations on CMMI’s new model during the webinar, “The Innovation in Behavioral Health (IBH) Model: CMMI’s Latest in Medicaid Innovation Frontier.”  

Our research highlights the unique characteristics and healthcare experience among dual eligible individuals with behavioral health needs. We examine demographic (race and ethnicity), health-related social needs, health status, access to care, relationship to providers and healthcare utilizations among those dual eligible individuals with behavioral health needs. This chartbook uses the national Medicare Current Beneficiary Survey for the analysis.

In response to Congress’ Request for Information to improve experiences for dual eligible individuals, ATI Advisory suggests key elements that would advance programmatic Medicare-Medicaid integration.