Health Affairs Forefront: CMS Proposed Policy Changes to Improve Care for Individuals Who Are Dually Eligible for Medicare and Medicaid

The Centers for Medicare & Medicaid Services (CMS) has taken another large step forward to ensure that dually eligible individuals can receive integrated care and services. In 2022, CMS provided states several new authorities to hold Medicare Advantage (MA) plans accountable and to ensure that individuals who are dually eligible for Medicare and Medicaid receive integrated care. In November 2023, CMS proposed another set of significant changes that could improve care and services, as well as unbiased counseling and information about enrollment choices for these individuals. Two innovative aspects stand out: First, the proposed key changes are set to take effect automatically. Second, the rule equips states with fresh tools to bolster integration efforts.

In Health Affairs Forefront, Michael Monson and Sarah Barth focus on the major provisions of the proposed rule. It is known that care integration has the potential to improve the quality of life for individuals who are dually eligible. Further limiting the “gaming” that Medicare Advantage plans play will limit confusion for individuals and create more conditions for integrated care across the Medicare and Medicaid programs. Furthermore, the ability of states to receive more timely, critical information will enable them to hold their health plans more accountable and to drive integration.

Read CMS Proposes Significant Policy Changes to Improve Care for Dually Eligible Individuals for 2025 in Health Affairs Forefront.

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