Examples of Potential Projects and Activities

Advancing Medicare & Medicaid Integration seeks to support states in their work to achieve meaningful improvements and advance the state toward full Medicare and Medicaid integration — measured by the degree of integration achieved and/or the share of the dual-eligible population impacted.

All projects funded under the Advancing Medicare & Medicaid Integration opportunity must address at least one of the initiative’s key objectives relating to integrating Medicare and Medicaid services for their dual-eligible population. States can work with Center for Health Care Strategies (CHCS) to: (1) consider states’ goals for integration and how they align with the initiative’s objectives; and (2) design project activities that support the initiative’s objectives. 

The state project activities supported by the Advancing Medicare & Medicaid Integration initiative should result in long-term policy and programmatic changes. Potential project activities could include:

• Model implementation. States might use this initiative to aid in the creation of Medicaid managed long-term services and supports programs that align with Dual Eligible Special Needs Plans (D-SNPs) or develop direct capitation contracts where D-SNPs cover Medicaid benefits.
• Evaluation and improvement. In states currently operating integrated Medicare-Medicaid programs, initiative support could be used to evaluate model effectiveness using quantitative and qualitative measures or refine program policies or operations based on evaluation findings to support states’ efforts to implement fully integrated D-SNP programs.
• Outreach and education. Stakeholder engagement is a crucial component of integrated care programs. Initiative support could be used to conduct surveys or focus groups, hold listening sessions or townhalls, or develop other communication tools that will be used to inform and address state policy goals and will have long-term impact. Support could also be used to conduct outreach and education for beneficiaries and providers around the value of integration using websites, marketing materials, or community events.
• Data analytics. Improvements in data analytic capabilities can benefit new or established integrated care programs. Initiative support could be used to build information technology infrastructure, contract with consulting services, expand staffing, or connect health plans or providers to health information exchanges. Support also can be used for quantitative analyses of Medicare and Medicaid data to better understand characteristics of dual-eligible populations or their patterns for service use or costs of care.
• Financial alignment. While the opportunity for shared savings is not explicitly supported and developed under current D-SNP policies, states may explore and consider several potential opportunities to financially align Medicaid payment rates with Medicare payment rates to allow states to share in savings that typically accrue to the Medicare program only.

With this opportunity, Arnold Ventures prioritizes ensuring that dual-eligible individuals have access to programs that fully integrate Medicare and Medicaid coverage through Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs) that are held accountable for delivering the full range of Medicare and Medicaid benefits. As states seek to advance Medicare and Medicaid integration and improve care for their dual-eligible populations, the Advancing Medicare & Medicaid Integration initiative provides an opportunity to support states that are focused on developing and implementing policies that position the states to move toward FIDE-SNP models.