May 17, 2019
Only 9 percent of beneficiaries who have full coverage in both Medicare and Medicaid (“full Duals”) are enrolled in managed care plans that integrate their Medicare and Medicaid coverage. The remaining “full Duals” are enrolled in separate Medicare and Medicaid coverage and must navigate a complex and confusing world of overlapping coverage and disconnected services.
In 2018, Congress enacted several significant changes in requirements for Medicare Advantage (MA) Duals Special Needs Plans (D-SNPs) that were aimed at advancing integration with Medicaid coverage for long-term services and supports (LTSS). While these provisions create a pathway for states to advance toward full integration, they do not do enough to accelerate the move toward integration. Many challenges and impediments to integration remain in place.
This MLTSS Association’s “Proposal to Advance Integration for Dual Eligible Beneficiaries” proposes regulatory and legislative changes to address barriers to integration and improve the integrated model for dually eligible beneficiaries, and recommends a strategy for advancing and growing the enrollment of dually eligible individuals in an integrated model.