Medicare-Medicaid Integration

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.

Compliance deadlines tied to the Access Rule's HCBS provisions will start to arrive in 2027, with additional milestones in 2028 through 2030. In a recent webinar, ATI experts Bill Hanna and Cleo Kordomenos were joined by Camille Dobson, deputy executive director at ADvancing States, to discuss next steps for impacted healthcare stakeholders.

Roughly 12 million individuals are dually eligible for Medicare and Medicaid. This population is tasked with navigating these two systems simultaneously, facing fragmentation that neither program was designed to manage. Despite the many integration-focused models and programs built in recent years, the question of whether integration delivers value remains unanswered. ATI expert Allison Rizer provides considerations for how Medicare-Medicaid integration outcomes can be measured in Health Affairs.

The Medicare Advantage market is entering a period of renewed opportunity for regional and local plans. As national carriers continue to retrench from select markets amid mounting financial pressure, regional and local organizations have continued to grow, with enrollment increasing by 3.5 and 9 percent respectively in 2026.

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.

While work requirements have captured the Medicaid policy conversation, CMS' Ensuring Access to Medicaid Services Final Rule (CMS-2442-F) is already moving from policy into implementation, with some provisions taking effect now and others phasing in through 2028 and beyond.