Initiative to Fund State Medicare-Medicaid Integration Projects

Dec. 16, 2021
Although better integration between the two programs can improve the quality and cost of care, only about 10 percent of dual-eligible individuals receive care through integrated programs

More than 12 million people in the United States, most with complex health and social needs, are eligible for both Medicare and Medicaid, a population often referred to as “dual-eligible.” With the Advancing Medicare & Medicaid Integration initiative, Arnold Ventures plans to provide funding to states to advance Medicare and Medicaid integration for dual-eligible individuals.

Dual-eligible individuals often have multiple chronic conditions and social service needs. Because Medicare and Medicaid were not designed to work together, this population often receives fragmented, uncoordinated care. Although better integration between the two programs can improve the quality and cost of care, only about 10 percent of dual-eligible individuals receive care through integrated programs.

Arnold Ventures, a private investment fund that focuses health care, education, criminal justice, and public finance, developed the Advancing Medicare & Medicaid Integration initiative in partnership with the Center for Health Care Strategies. It seeks to support states in their work to achieve meaningful improvements in Medicare and Medicaid integration — measured by the degree of integration achieved and/or the share of the dual-eligible population impacted.

Funding will vary based on project size and scope. Typical awards will be between $500,000 to $1 million. Project durations may vary based on the scope of work but should be no more than 36 months.

According to the initiative’s website, potential project activities could include:

• Capacity assessment. State staffing capacity, skills, and knowledge are key to successfully launching any program serving dual-eligible individuals. Initiative support could be used to hire new staff or engage consultants, build expertise in Medicare and integrated care, or develop knowledge of community-based organizations or others serving dual-eligible populations.

• Model implementation. States seeking to implement larger-scale shifts in care delivery might use this initiative to aid in the creation of Medicaid managed long-term services and supports programs that align with Dual Eligible Special Needs Plans (D-SNPs), develop direct capitation contracts where D-SNPs cover Medicaid benefits, or design new demonstration programs under CMS’ Financial Alignment Initiative or new state-specific demonstration models.

• Evaluation and improvement. In states currently operating integrated Medicare-Medicaid programs, initiative support could be used to evaluate model effectiveness using quantitative and qualitative measures or refine program policies or operations based on evaluation findings.

• Outreach and education. Stakeholder engagement is a crucial component of integrated care programs. Initiative support could be used to conduct surveys or focus groups, hold listening sessions or townhalls, or develop other communication tools. Support could also be used to conduct outreach and education for beneficiaries and providers around the value of integration using websites, marketing materials, or community events.

• Data analytics. Improvements in data analytic capabilities can benefit new or established integrated care programs. Initiative support could be used to build information technology infrastructure, contract with consulting services, expand staffing, or connect health plans or providers to health information exchanges. Support also can be used for quantitative analyses of Medicare and Medicaid data to better understand characteristics of dual-eligible populations or their patterns for service use or costs of care.

Projects may be operated in capitated or fee-for-service Medicaid delivery systems and include all of a state’s dual-eligible population or a subset, Arnold Ventures said. The scale of a state’s proposed project may vary depending on factors including previous efforts to integrate Medicare and Medicaid, experience with Medicaid managed care, state staffing and data analytic capabilities, and degree of stakeholder buy-in. States may propose projects that make a single large-scale shift in care delivery or several smaller-scale changes that represent a significant advancement in the degree of integration achieved or in the size of integrated care enrollment.

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