Advancing Better Programs for Individuals Eligible for Both Medicare and Medicaid
For the 12.5 million individuals who are eligible for both Medicare and Medicaid or “dually eligible,” access to integrated and coordinated care and services can be challenging. To qualify, these individuals must meet national requirements for Medicare (either 65 or older, and/or younger with a qualifying disability) and Medicaid requirements which include state-specific requirements. These populations are low income and very diverse in race, ethnicity, age, gender, disability, cognitive ability, physical and behavioral health status, and social circumstances which may require varied program approaches. The individuals must navigate multiple and often complicated eligibility determination, enrollment, and program structures for Medicare and Medicaid.
States are often challenged in administering programs for dually-eligible individuals because Medicare and Medicaid were not created to work together. State officials have many competing priorities. They often do not have staff with deep Medicare subject matter expertise to navigate the complexities of the Medicare and Medicaid programs’ requirements and advance how they may work together better to provide holistic and person-centered care, as well as more efficient program administration and oversight.
Altarum Medicare-Medicaid Services for States (AMMS) was created in 2022 to meet an identified need to bolster state capacity to build better programs for dually eligible individuals. AMMS combines a data-driven analytic approach with extensive national and state expertise around the dually eligible population, and the programs that serve them. It has extensive experience in Medicare-Medicaid integration and Medicaid long-term services and supports program policy and administration. Its experts meet states where they are on their journey to sustainable solutions that advance health, health equity, wellness, and independent living for dually eligible individuals. AMMS offers state-tailored services in strategy and program design, as well as administrative and operational support, data analytics and communications, to build and enhance state capacity. We take a holistic, partnership approach to our work with states and dually eligible individuals and their families and caregivers, their providers, and often their health plans.
Improving Individuals’ Experiences and Maximizing Public Funding
AMMS partners with states to tailor solutions to the unique characteristics, needs, and preferences of their dually eligible populations. We understand that these populations are diverse in race, ethnicity, age, gender, disability, cognitive ability, physical and behavioral health status, and social circumstances which may require varied program approaches. Most access care and supports that are fragmented across the Medicare and Medicaid programs. There is a significant opportunity to enhance and better align these programs to improve individuals’ experiences, outcomes, and quality of life. States also have an opportunity to address the cost-shifting that occurs between the two programs and ensure Medicaid is payer of last resort
Partnering to Expand State Capacity
Not many people have deep Medicare-Medicaid integration expertise, and there are few who have both policy and program administration experience. As a result, states are challenged to identify and hire the best people to advance Medicare-Medicaid integration. AMMS helps states gain and expand in-house capacity.
Explore our our approach and our impact.