About the Project
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 Person-Centered Enrollment Strategies for Integrated Care, 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 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 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?
Findings and recommendations from our research have been published and are available here.
About the Toolkit
Alongside the publication of our findings and recommendations, we developed this toolkit, which can be used by federal and state policymakers, health plans and other organizations engaging with dually eligible beneficiaries.
The toolkit includes the following sections:
- Top Five Things Health Plans Can Do to Support Dually Individuals’ Participation in Integrated Care
- Top Five Things Federal Government Can Do to Support Dually Eligible Individuals’ Participation in Integrated Care
- Top Five Things State Medicaid Agencies Can Do to Support Dually Eligible Individuals’ Participation in Integrated Care
- Top Five Things Policymakers Can Do to Improve Enrollment Notices
- Resources on Medicare-Medicaid Enrollees
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
Project Advisory Committee
We 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
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 toolkit was supported by Arnold Ventures.
This toolkit 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.
If you have questions or comments on this toolkit, please contact Leena Sharma at firstname.lastname@example.org.