November 9, 2009

Supporting Alternative Integrated Models for Dual Eligibles: A Legal Analysis of Current and Future Options

This article was written by Sara Rosenbaum, George Washington University, Jane Hyatt Thorpe, George Washington University, and Sara Schroth, George Washington University. Among the most pressing health care reform issues likely to be left for future policy debate is how to advance integration of care for those who are eligible for both Medicare and Medicaid ("dual eligibles"). Ironically, these beneficiaries are the ones most likely to be in fragmented fee-for-service systems of care. The resulting costs are enormous. Unfortunately, existing policies present myriad barriers to innovations in care at the state and local levels. The Center for Health Care Strategies, Inc. (CHCS) turned to its expert colleagues at George Washington University's Department of Health Policy (GW) to conduct an analysis of the current legal and regulatory barriers and possible avenues for working within them to integrate care for dual eligibles. While special needs plans (SNPs) authorized under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) have significant potential for integrating care, much has already been written about SNPs as a vehicle to pursue integration. Thus, this inquiry focuses on alternative vehicles for achieving integration.