For too long, many individuals dually eligible for both Medicare and Medicaid, and the providers who serve them, have been forced to cobble together services from disparate and complex health care delivery systems. Both providers and health plans have to navigate different programmatic rules, duplicative administrative hurdles and conflicting incentives between of the two programs, resulting in massive inefficiencies and gaps in care.

The unfortunate reality is that this misalignment between the two programs may result in lower quality, uncoordinated care for some individuals dually eligible for Medicare and Medicaid. Even for the 10 percent of this population enrolled in Medicare Advantage, the different administrative processes, payment streams and financial incentives have largely undermined efforts to coordinate care across programs in a meaningful way. This means beneficiaries experience confusion and dissatisfaction, as well as higher costs and compromised health status.

The Centers for Medicare and Medicaid Services (CMS) is responsible for one of the most important opportunities to make fundamental changes to the health care system by testing approaches for integrating care for the Medicare and Medicaid dually eligible population. Medicare and Medicaid can and must work in partnership to do better than the status quo for their shared members.

NAMD strongly supports the partnership with states forged through CMS’ Medicare-Medicaid Coordination Office. NAMD supports the Duals Office’s work to identify and incorporate the core strengths of the Medicare and Medicaid programs as states design, administer and evaluate new delivery system demonstration models to improve the health for this population. Working in concert with CMS, state Medicaid agencies have crafted their proposals to ensure not only continuity of services, but providers as well, and higher quality care that leads to desirable outcomes. States are committed to working with stakeholders and with CMS to align systems in ways that will benefit, and not harm, members.

States and federal partners have a lot of work to do to better align the Medicare and Medicaid programs, but the scale of the system improvements should not deter policymakers. As they have done with other system reforms before, Medicaid agencies will learn which approaches work best, and the delivery models will evolve to reflect these best practices. The outcomes of these demonstrations will serve to lead us to the fundamental reforms that these vulnerable individuals need and deserve.

NAMD Submits Comments on New Direction for CMMI

On November 20, NAMD submitted comments to a CMS Request for Information regarding future directions for the Center for Medicare and Medicaid Innovation (CMMI). NAMD calls for a stronger partnership between states and CMMI to promote further demonstration and alternative payment model alignment, and provides several specific issue areas where this partnership can be applied […]

NAMD Sends Letter to Hill on CHIP and D-SNP Reauthorization

This letter articulates Medicaid Directors’ requests for federal policymakers to provide states with certainty of the ongoing federal commitment around two key programs: first, the Children’s Health Insurance Program (CHIP), and second, the Medicare Advantage Duals – Special Needs Plans (D-SNPs) program. These actions can provide states with the budgetary and operational certainty they need […]

NAMD Submits Comments on Future of HCBS

On January 9, NAMD provided comments in response to a CMS Request for Information seeking stakeholder input on a variety of questions addressing the provision of Medicaid home and community-based services (HCBS). In the comments, NAMD calls for CMS to be mindful of states’ unique role in HCBS program administration and the continually evolving HCBS […]

NAMD Legislative and Regulatory Priorities for 2017

NAMD’s legislative and regulatory priority documents outline opportunities to modernize the federal rules governing Medicaid to ensure these comport with the realities and expectations for states to run high performing Medicaid programs. NAMD believes these modernizations – in federal statute and in federal regulation – can have a meaningful, positive impact for Medicaid enrollees. See […]

Considerations for an Integrated ACO Concept for Dually Eligible Individuals

This issues brief explores the concept of an integrated ACO model for dually eligible individuals and outlines issues policymakers would need to consider in the design of such an approach. These considerations include: the role of state partnership, timely integrated Medicare and Medicaid data, quality measure alignment, the heterogeneity of the dually eligible population, and […]