10 Opportunities to Better Serve Individuals Dually Eligible for Medicaid and Medicare

December 20, 2018

Today, the Centers for Medicare & Medicaid Services (CMS) sent a letter to state Medicaid directors that outlines both existing and new opportunities for states to better serve individuals dually-eligible for Medicare and Medicaid. The letter highlights opportunities to implement new developments with Managed Care, use Medicare data to inform care coordination and program integrity initiatives, and reduce administrative burden for dually-eligible beneficiaries and the providers who serve them.

There are over 12 million Americans enrolled in both the Medicaid and Medicare programs. The programs continue to have different rules for eligibility, covered benefits, and payment, and operate as separate and distinct. Dually-eligible individuals experience high rates of chronic illness, with many having multiple chronic conditions and/or social risk factors. Forty one percent of dually-eligible beneficiaries have at least one mental health diagnosis, and about half use Long Term Services and Supports (LTSS).

The letter describes ten opportunities – none of which require complex demonstrations or Medicare waivers – to better serve individuals dually-eligible for Medicare and Medicaid. CMS often receives feedback from states interested in how Medicare and Medicaid can work better together. A number of states have already launched ambitious initiatives to better serve dually-eligible individuals, including those states that are testing demonstrations, such as the models under the Medicare-Medicaid Financial Alignment Initiative, in collaboration with CMS. We will be outlining new demonstration-related opportunities for these and other states in the coming months.

The State Medicaid Director Letter is available on Medicaid.gov: https://www.medicaid.gov/federal-policy-Guidance/index.html.