For individuals dually eligible for Medicare and Medicaid, misaligned incentives across these programs can result in higher costs and worse health outcomes. As a result, policymakers have been especially interested in developing integrated programs to better coordinate services. Current programs, such as the Financial Alignment Initiative (FAI) and Fully Integrated Special Needs Plans (FIDE SNP), aim to coordinate medical, behavioral, and long-term services and supports, but have struggled with low enrollment.

The Center for Community Engagement in Health Innovation conducted research to better understand enrollment policies and practices that take into consideration dually eligible individuals’ perspectives.

We launched a three-pronged research project aimed at understanding whether integrated care plans, specifically Medicare-Medicaid plans offered through the FAI, meet the needs of dually eligible individuals.

We collected information for our study in three ways: (1) a document and literature review; (2) consumer data; and (3) enrollment stakeholder data. We also convened an advisory committee to help guide us in our analysis and the development of our recommendations.

Our Approach

Our primary research questions were:

  • What factors are associated with enrollment in the FAI and which appear to be most important to dually eligible individuals?
  • What best practices could federal policymakers, state policymakers, integrated care plans, and other stakeholders employ to increase participation in integrated products in a person-centered way?

Our report contains our findings and recommendations, based on interviews with a variety of stakeholders, including dually eligible individuals who have participated in integrated care plans, as well as those who have chosen not to, or opted out of such a plan.

State Advocacy Partners

We would like to express our deep gratitude to the state advocacy partners in California, Illinois, Massachusetts, and Ohio for their role in recruiting dually eligible individuals to participate in focus groups.

Aileen Harper, Center for Health Care Rights

Elizabeth Durkin and Stella Van Den Eeden, AgeOptions

Bill Henning, Boston Center for Independent Living & Dennis Heaphy, Disability Policy Consortium

Steve Wagner, UHCAN Ohio

Advisory Committee

We also offer our deep appreciation for the guidance and feedback from the project advisory committee:

  • Melanie Bella, Cityblock Health
  • Tom Betlach, Speire Healthcare Strategies.
  • RoAnne Chaney, Michigan Disability Rights Coalition
  • Christine Aguiar Lynch, Association for Community Affiliated Plans
  • Robert Master, former CEO Commonwealth Care Alliance
  • Kevin Prindiville, Justice in Aging

Focus Groups

Finally, we want to thank each of the Medicare-Medicaid enrollees who participated in our focus groups. Their perspectives offered invaluable insights and we appreciate their time.


This project was supported by Arnold Ventures.

This project was also supported by a grant from The SCAN Foundation — advancing a coordinated and easily navigated system of high-quality services for older adults that preserve dignity and independence.