Medicare and Medicaid Integration 

Background

Approximately 9.2 million Americans are covered simulataneously by both Medicare and Medicaid, a population commonly known as “dual eligibles.” Integration and coordination of care is crucial for keeping down costs while providing quality care to this vulnerable population. Accomplishing this task will require new and innovative payment and delivery system, as well as partnerships between the federal and state goverments, community health plans and provders. Large-scale savings can be achieved in transitioning the dual eligible population into a fully integrated, capitated setting like a managed care organization (MCO). In addition, MCOs have been shown to provide greater outreach, case management and other non-financial benefits.

ACAP Position and Legislative Action

After years of little coordination, the Patient Protection and Affordable Care Act established an office in the Department of Health and Human Services focused on intergrating its policy treatment of dual eligibles.

ACAP urges all parties to work toward increasing Medicare and Medicaid integration in order to provide high quality and coordinated care to dual eligibiles.