Senators Request Public Input to Inform Decision Making on Programs Serving Dual Eligible Enrollees

Health EquityPolicy Analysis and DevelopmentStakeholder Engagement and FacilitationMedicaid-Medicare IntegrationsMaternal and Child Health

Mar 1

Written By

In November 2022, United States Senators Cassidy, Carper, Scott, Warner, Cornyn, and Menendez issued a request for information (RFI) regarding approaches for improving coverage for individuals who are dually eligible for Medicare and Medicaid. Dual eligible beneficiaries are more likely to have complex health needs that are difficult and often expensive to treat. Too often, they experience a lack of integration and coordination that often results in confusing encounters with the health care system and negative health outcomes.For more than 10 years, Aurrera Health Group has supported the California Department of Health Care Services (DHCS) with policy development and implementation of integrated programs for dual eligible beneficiaries. Our experience ranges from facilitating stakeholder engagement processes to inform the design and implementation of the Coordinated Care Initiative (CCI) and Cal MediConnect — California’s Financial Alignment Initiative (FAI) — to community and provider outreach and education programming, to State Medicaid Agency Contract (SMAC) research and development for participating managed care plans. Most recently, we supported DHCS with the planning and implementation of the CalAIM initiative, including the transition from CCI to a statewide Dual Eligible Special Needs Plans (DSNPs) and Managed Long-Term Services and Support structure.Given this experience, Aurrera Health was encouraged by the Senators’ release of this RFI and the attention they are giving to this complex population. The letter requested information on whether we should improve current systems of care for dual eligible enrollees, or develop a new, unified system.As we noted in our response, either approach has merits, and the decision making can be informed by the progress states and the federal government have made implementing models of integrated programs for dual eligible enrollees, including the FAI, combinations of D-SNPs with Medicaid managed care including aligned enrollment plans discussed above, and the Program of All Inclusive Care for the Elderly (PACE). Each model has evidence of success in some areas, and each may better suit certain beneficiaries or state circumstances, as shown in recent reports from the Assistant Secretary for Planning and Evaluation and Medicaid and CHIP Payment and Access Commission. Common factors that may drive success in these models factors could be strengthened within existing models or they could be considerations in designing a new system informed by these lessons learned. You can find our response to the RFI and a round-up of other submissions below.