Navigating Care for Dual Eligible Individuals: Paving the Way for Medicare and Medicaid Integration

For nearly two years, Health Affairs and Arnold Ventures have collaborated on the Forefront article series focusing on integrating Medicare and Medicaid. This October, I was asked to speak at a briefing connected to this series called Key Challenges Encountered By The Medicare and Medicaid Dually-Eligible Population. The discussion addressed the challenges and potential solutions related to policy, health plan capacity, engagement with community-based organizations, and the importance of tailoring services to meet local needs. Other panelists included Kelli Emans, a state official in Washington state; Dennis Heaphy, a researcher at the Disability Policy Consortium and Commissioner with the Medicaid and CHIP Payment and Access Commission; Laura Keohane, an Associate Professor at Vanderbilt University; Olivia Richard, an advocate at the Camden Coalition; and Brandon Wilson, a Senior Director at the Center for Community Engagement in Health Innovation.

Key Takeaways

In my opening remarks, I shared several insights regarding the need for integrated and equitable approaches that better serve dual eligible individuals:

1. Navigating the Complex Stakeholder Landscape: I've seen firsthand the complexity of serving dual eligible individuals. It's not simply Medicare and Medicaid; serving this population involves a host of entities, like various waiver administration agencies, managed care plans, and programs for housing support, food security, and more. Addressing the diverse needs of this population requires us to coordinate across stakeholders with a person-centered approach.

2. Utilizing Stakeholder Engagement: Aurrera Health Group currently supports California’s Department of Health Care Services (DHCS) in implementing exclusively aligned enrollment dual eligible special needs plans (EAE D-SNPs) as the next step in its evolution of Medicare-Medicaid integration following the Cal MediConnect Financial Alignment Initiative. A great deal of work has been put into creating channels for DHCS to gather stakeholder feedback as part of their decision-making process. This is vital for creating policies that reflect the needs and preferences of stakeholders they impact, building trust, and facilitating ongoing communication to address emerging issues and drive continuous improvement in programs.

3. Addressing Equity Issues: I mentioned a recent report from Community Catalyst on home and community-based services (HCBS) equity issues for dual eligible populations, driven by interviews and focus groups. The report’s findings reveal unmet needs and limited access to culturally and linguistically appropriate HCBS, underscoring the importance of gathering detailed and diverse feedback to identify where we need to focus our efforts to address these challenges.

Following opening remarks by each panelist was an engaging discussion on issues including challenges dual eligible individuals face in obtaining durable medical equipment, improving care for dual eligible individuals with intellectual and developmental disabilities, and the resources states need to design and implement integrated care programs. I look forward to applying what I learned during the briefing to our Medicaid-Medicare integration work at Aurrera Health Group.

Even More in Health Affairs Forefront Series

My colleagues Sasha Hulsey, Cassidy Acosta, and Alisa Chester also recently authored an article, Building Trust for Change: Lessons on Stakeholder Engagement from California's Integrated Care Models, that was featured in the Forefront series. The article explores California's experience with transitioning integrated care models for dual eligible individuals and provides lessons learned for other states considering similar options.

Our Role in Supporting Integrated Care for Dual Eligible Individuals in California

Aurrera Health Group has supported DHCS since 2011 in enhancing care for dual eligible individuals through the Coordinated Care Initiative (CCI) and Cal MediConnect. These programs were rolled out to seven California counties, resulting in the enrollment of over 107,000 dually eligible Californians. Our role encompassed strategic policy development, robust stakeholder engagement, and executing comprehensive education and outreach efforts. We are currently helping DHCS build on successes and lessons learned from the CCI to expand integrated care for dual eligible individuals statewide.To learn more about Aurrera Health’s work on Medicare-Medicaid integration in California, or to discuss our capabilities to support your state in similar initiatives, please reach out to my colleague Mary Russell or me.

Watch the Recording

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Authors

Kristal Vardaman [Managing Principal]