Briefs & Reports

HMA Briefs on Medicare-Medicaid Integration

This issue brief from Health Management Associates, Medicare-Medicaid Integration: Essential Program Elements and Policy Recommendations for Integrated Care Programs for Dually Eligible Individuals is part of a multi-phased research initiative to increase enrollment in integrated care programs (ICPs)[1] that meet full benefit dually eligible individuals’[2] needs and preferences. Dually eligible individuals have a range of chronic conditions and disabilities requiring both Medicare and Medicaid services, which makes integrated programs important to their lives.

For a succinct overview of the essential elements and policy recommendations, please access the brief fact sheet. For a full discussion of the elements and policy recommendations, please access the full brief.

The authors are Sarah Barth, Ellen Breslin, Samantha DiPaola and Narda Ipakchi.[3]

For further information or questions, contact Sarah Barth at sbarth@healthmanagement.com, Ellen Breslin at ebreslin@healthmanagement.com, or Samantha DiPaola at sdipaola@healthmanagement.com.

[1] Integrated Care Programs (ICPs): For this research, we defined ICPs as financing and care delivery organizing entities or programs that coordinate and integrate Medicare and Medicaid-covered services and supports for dually eligible individuals.They include the Centers for Medicare & Medicaid Services (CMS) Financial Alignment Initiative (FAI) capitated and fee-for-service models; the Program of All-Inclusive Care for the Elderly (PACE); Medicare Advantage (MA) Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs); Medicaid Managed Long-Term Service and Supports Program (MLTSS) managed care organizations and aligned MA dual eligible special needs plans (D-SNPs); and state-specific programs that may be proposed to CMS.

[2] Dually Eligible Individuals: When using the term dually eligible individuals, we are referencing Medicare-Medicaid full benefit dually eligible individuals (FBDEs), those who qualify for full Medicaid benefits.

[3] Narda Ipakchi was formerly a Senior Consultant with HMA.

Download