Today less than 10 percent of “full Duals” (beneficiaries who have full coverage in both Medicare and Medicaid) are enrolled in managed care plans that integrate their Medicare and Medicaid coverage. The remaining “full Duals” are enrolled in separate Medicare and Medicaid coverage and must navigate a complex and confusing world of overlapping coverage and disconnected services. In 2018, Congress enacted several significant changes as part of the Balanced Budget Act of 2018 that were aimed at strengthening Medicare-Medicaid integration requirements for Medicare Advantage (MA) Duals Special Needs Plans (D-SNPs). While these provisions create a pathway for states to advance toward full integration, many barriers remain.
The National MLTSS Health Plan Association has developed a series of policy proposals to address existing barriers to integration and to advance and grow the enrollment of dually eligible individuals in an integrated model.
Read the Association's policy proposals here.