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Integrating care for people dually eligible for and enrolled in Medicare and Medicaid remains a bipartisan policy priority. Because Medicare and Medicaid are administered and funded separately, most dual-eligible beneficiaries receive coverage through two distinct programs with separate budgets, which lack financial incentives to coordinate care. To address these misaligned payment incentives, much of policy makers’ efforts have focused on increasing the financial integration of insurance coverage and benefits between Medicare and Medicaid through Medicare Advantage (MA) Dual-Eligible Special Needs Plans (D-SNPs).
In 2024, however, only 6.2 percent of dual-eligible beneficiaries were enrolled in plans attaining a high level of financial integration, in which one organization or managed care plan coordinates care and bears financial risk for both Medicare and Medicaid services (see exhibit 1). Furthermore, only 14.7 percent of dual-eligible beneficiaries were enrolled in plans that offer moderate levels of integration, which means they bear some Medicaid risk in addition to Medicare risk. An additional 26.2 percent of dual-eligible beneficiaries were enrolled in plans with low-level integration that coordinate some Medicaid services but do not bear any Medicaid risk (with the exception of some plans in California with aligned enrollment across Medicare and Medicaid). Meanwhile, 34.1 percent of dual-eligible beneficiaries remain in traditional Medicare (TM) and another 18.7 percent in other non-integrated MA plans, none of which coordinate or financially integrate services with Medicaid.