Demonstrations to Improve the Coordination of Medicare and Medicaid for Dually Eligible Beneficiaries

This brief reviews the prior experience in states participating in the initiative and in the health plans in operating Medicare Advantage or Medicaid Managed Care (MMC) plans within the states, particularly those with financial alignment demonstrations currently underway.  The prior experience of states and health plans provides a foundation for understanding the existing infrastructure for implementing these demonstrations. States that are experienced in working with managed care plans, even if for other populations, are more likely to have expertise in setting capitation rates, negotiating terms for the contracts with plans, monitoring the quality of care, and overseeing the enrollment process. States’ prior experience may also be a proxy for how familiar beneficiaries and providers in the state are with similar capitated programs.   Health plans with prior experience in providing coverage for dually-eligible beneficiaries (or for those with just Medicare or Medicaid) are more likely to be familiar with the significant needs of this population, and the rules pertaining to various aspects of operating a plan (e.g., appeals and grievances, network requirements, enrollment procedures) and benefits that could ease implementation of the demonstration.