Medicaid Integration

KFF’s analysis released March 2, 2023, “Medicaid Enrollment Growth: Estimates by State and Eligibility Group Show Who may be at Risk as Continuous Enrollment Ends”, presents findings from the organization’s evaluation of Medicaid and Children’s Health Insurance Program (CHIP) enrollment data. KFF estimates nearly 95 million people enrolled in Medicaid and CHIP in March 2023 – an increase of 23.3 million enrollees with over half of the enrollee increase among adults under age 65 and nearly one-third among children. Also, five states – California, New York, Texas, Florida, and Illinois – comprise over one-third of the increase in Medicaid and CHIP enrollment while the rate of growth in enrollment varies among states.

MACPAC has released its June 2022 Report to Congress on Medicaid and CHIP. The report recommends measures that Congress can take to better monitor access to care for Medicaid beneficiaries, improve the oversight and transparency of managed care directed payments, increase access to vaccines for adults enrolled in Medicaid, encourage the uptake of health information technology in behavioral health, and better integrate care for Medicaid and Medicare dual-eligibles. The commission also offers policy levers that states and the federal government can use to promote equity in Medicaid.

Prior to COVID-19, Indiana hosted stakeholder workgroups to identify needed improvements to its Medicaid-funded long-term services and supports (LTSS) system. The pandemic amplified existing disparities, including inequitable access to community-based care, unaligned and uncoordinated care for dually eligible individuals, and broad gaps in capacity and resources to effectively oversee and implement the LTSS reform effort. With support from Arnold Ventures, Indiana’s Family and Social Services Administration (IN FSSA) is working with project partners to design a Medicare-Medicaid integration strategy for dually eligible individuals enrolled in MLTSS and engage providers in its development process.

This publication from Health Management Associates analyzes the approaches that Medicaid programs in DC, Idaho, Maine, Washington and Alabama used to coordinate Medicare and Medicaid services without standalone Medicaid MLTSS programs. The paper focuses on Medicaid and Aging agencies overseeing programs that provide long-term services and supports fee for service and explores effective methods to coordinate and integrate care with Medicare Advantage Dual Eligible Special Needs Plans.

Supported by Arnold Ventures, Mathematica conducted this study to understand what leads dually eligible beneficiaries to remain in, or disenroll from, D-SNPs. They examined the association of MA quality and member experience scores, and level of Medicaid integration, with voluntary disenrollment rates (VDRs) in D-SNP dominant MA contracts. Download the publication to read more.

The Medicaid and CHIP Payment and Access Commission (MACPAC) released the 2020 edition of the MACStats: Medicaid and CHIP Data Book, with updated data on national and state Medicaid and State Children’s Health Insurance Program (CHIP) enrollment, spending, benefits, and beneficiaries’ health, service use, and access to care. MACStats brings together the range of Medicaid and CHIP statistics, including eligibility and enrollment, benefits, service use and access to care.

ATI Advisory released extensive data analysis of Medicare claims data to highlight the disparate impact of the COVID-19 pandemic on individuals eligible for both Medicare and Medicaid (dual eligibles).The analysis also offers policy pathways for states to improve integrated care for this vulnerable population.

CHCS and Speire Healthcare Strategies released a report about COVID-19 response efforts from states and health plans that offer integrated care programs for duals. People who are dually eligible for Medicare and Medicaid are among the nation’s most vulnerable to the coronavirus. The report outlines opportunities to support integration and identifies opportunities to strengthen programs and policies to best support the dual eligible population during the pandemic and in the future.

This issue brief from the MLTSS Institute focuses on aspects of delivering effective care to individuals eligible for both Medicare and Medicaid (dually eligible individuals).The brief provides a primer on the ways that Medicare data can help states better deliver care to dually eligible individuals; it also details information about data sources and other resources available to help obtain and analyze Medicare data.

This brief draws from interviews with states operating new and long-standing MLTSS programs to identify six major trends in the refinement of MLTSS and underlying LTSS delivery systems nationally. The states examined in this brief are strengthening their Medicaid MLTSS programs to serve more LTSS beneficiaries and facilitate the development of integrated care programs that reduce service fragmentation for Medicare-Medicaid enrollees, particularly through Medicare Advantage D-SNPs