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DATA

State-Level Access to Integrated Health Plans

Review Data

Federal Policy is Necessary to Improve Access to Integrated Models

Integrating Medicare and Medicaid services for people who are dually eligible for both programs can improve outcomes and lower costs compared to unintegrated coverage that requires people who are dually eligible to navigate the complexities of multiple insurance programs largely alone.

Despite progress in recent years, people who are dually eligible in 28 states do not have access to an integrated model. If accounting for PACE—a model that integrates Medicare and Medicaid, but not all people who are dually eligible meet the criteria to enroll in it—the number drops to 13 states.

Members of the Medicare-Medicaid Integration Alliance believe that all people who are dually eligible should have access to meaningfully integrated coverage, no matter where they live, and federal policy change is important to making that happen.

% of People Dually Eligible With Access to Integrated Plans by State in 2021 + 2026

Compare years:

Compare PACE:

without PACE
with PACE*
26.5 million Americans
are dually eligible
10% have access to
integrated plans

* if individuals meet PACE qualification criteria

HIDE-SNP: Highly Integrated Dual-Eligible Special Needs Plan

FIDE-SNP: Fully Integrated Dual-Eligible Special Needs Plan

PACE: Program of All-Inclusive Care for the Elderly

Percent of dually eligible population
with access to an integrated plan

0% 50% 100%
without PACE with PACE
without PACE with PACE
Source Data

Steps Federal Policymakers Can Take to Improve Access to Integrated Models

Federal policymakers have already made meaningful strides to protect and strengthen integration, but more can be done to improve access and improve upon integrated models.

For example:

  • Require every state to make an integrated model available to their dually eligible population.
  • Define integrated care to ensure that the two programs feel like one to people enrolled in them and the providers that serve them, include meaningful support to help people navigate the system, and ensure people maintain access to the benefits they are entitled to.
  • Support states with the development and management of their integrated programs.

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