Partnering with States to Advance 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.

We are currently working with states, including Tennessee, Maine, and Michigan, to enhance the quality, experience of care and services, efficacy, and cost efficiency of programs that serve dually eligible individuals.

Partnering to build a stronger program in Tennessee

AMMS is partnering with Tennessee to build upon its current dual integration program to enroll more people in this program that was specifically designed to meet their needs and preferences and advance health equity and cost efficiencies of the program. This includes:

  • Program strategy and design
  • Program implementation, administration, and oversight
  • Quality measurement
  • Medicare Advantage Special Needs Plans consultation
  • State Medicaid agency contract support
  • Cost efficiency and savings efforts
  • Staff extension services

Charting a program path for Maine

AMMS is providing population and program expertise to Maine to help chart a path to strengthen state capacity to develop, oversee and implement approaches to better integrate Medicare and Medicaid for individuals served and advance a more efficient, coordinated program structure. Our work includes producing a dual eligible population landscape analysis, a systems and oversight analysis, and roadmap for moving forward.

Helping Michigan transform a demonstration program into a permanent program

AMMS is helping the state transition a dual eligible demonstration program to continue to provide the most integrated and tailored program option possible for dually eligible individuals in Michigan. We are providing hands-on project management and program expertise supporting on-the-ground program staff and serving as advisors to Michigan Medicaid leadership. Our work includes supporting the development and release of a request for proposal for its new integrated program.

Sarah Barth, Executive Director, AMMS, says, “States value working with AMMS not only because we have on-the-ground implementation and policy expertise, but also because we sit down with the states and their teams and really listen to what they are wrestling with. We help them identify solutions and then bolster and grow internal capacity to grow and support these programs.”

She further explains, “States also benefit from the experience of knowledge sharing; they hear what is and is not working in other states, not just about policy, but about states’ ‘on the ground experiences’ working with a population which is dually eligible.”