Health Affairs December 11, 2023
More than nine million people are fully eligible for both Medicare and Medicaid benefits. These individuals must navigate two systems of care with different benefit structures, provider networks, cost structures, and administrative rules and policies. This complexity would be difficult for anyone, but full-benefit dually eligible individuals also often have multiple chronic physical and behavioral health conditions, functional limitations, and social support needs, not to mention lower levels of health literacy and language barriers, that make the task all the more challenging.
Models such as the Program of All-Inclusive Care for the Elderly (PACE), Medicare Medicaid plans in demonstrations under the federal Financial Alignment Initiative, and Dual Eligible Special Needs Plans (D-SNPs) in the Medicare Advantage program are all designed...
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