Individuals who are enrolled in both Medicare and Medicaid—often referred to as dually eligible—are a diverse population. While they usually have lower incomes and little savings, they differ greatly in terms of demographic, socioeconomic, and health characteristics—comprising adults over age 65 with limited financial resources and diverse health and disability status, individuals with lifelong intellectual or developmental disabilities, and people under age 65 with significant physical or cognitive disabilities. Dually eligible individuals are more likely to report being in poor health than Medicare-only enrollees and nearly half report a limitation in their activities of daily living. They also encounter other difficulties such as housing instability and limited transportation. As a result of these myriad challenges, many rely on care and support that are fragmented across the Medicare and Medicaid programs.
Consequently, when it comes to providing care solutions for their dually eligible populations, states have an opportunity to both improve individuals’ experiences through tailored plans and maximize public funding by increasing care coordination between the Medicare and Medicaid programs. Altarum Medicare-Medicaid Services for States (AMMS) offers states the expertise and support they need to accomplish these objectives.
Formed in 2022, AMMS is a nonprofit subsidiary of Altarum that helps states create financially sustainable solutions to advance health, health equity, wellness, and independent living for dually eligible individuals through Medicare-Medicaid integration. We enhance state capacity by providing exceptional national expertise around dual eligible and long-term services and supports (LTSS) policy and program administration. Our state-specific, data-driven approaches improve health equity and outcomes while efficiently managing Medicaid dollars.
Just as diverse dually eligible individuals require varied program approaches, AMMS tailors its services to meet states where they are on the continuum of knowledge, capacity, and expertise. We assess current situations and offer states phased-in approaches to integration to achieve person-centered care—from gaining Medicare proficiency to implementing fully integrated programs—including transitioning to integrated dual eligible special needs plans (D-SNPs).
AMMS’ services span:
- Strategy and Program Design including data analysis of state dually eligible populations and identifying paths to improve care coordination and integration
- Administrative and Operational Support including direct project and program management and assisting states to use regulatory and contractual tools such as developing and operationalizing State Medicaid agency contracts with D-SNPs
- Communications including developing comprehensive internal and external communication plans, conducting stakeholder engagement meetings and regional forums, and managing state internal and external workgroups and relationships
While AMMS operates as a shared service between states, success is defined based on each state’s individual goals. These may include improved quality and outcome measures, more dually eligible individuals living independently in their communities, increased cost efficiencies, and the wider availability of, and greater enrollment in, integrated programs.
AMMS, in service to states, is a hallmark of Altarum’s ability to innovate solutions to advance health equity – to recognize a challenge and develop a customizable solution for states wherever they are on their journey to improving care for dually eligible individuals.