The Medicare/Medicaid Integration Program helped states integrate — or move toward integration of — acute care and long-term care for dual eliglbles (low-income elders and people who are disabled who are eligible for both Medicare and Medicaid) who are enrolled in Medicare and Medicaid managed care.

The fragmented U.S. health care system has caused dual eligibles many problems in getting adequate care. Acute care, covered by Medicare, and long-term care, covered by Medicaid, are rarely integrated, leading not only to poor patient care but to serious clinical, financial and administrative inefficiencies.

The growth of managed care in the 1990s seemed to many to present an opportunity — and organizational vehicle — to provide integrated acute and long-term care to dual eligibles.

From 1997 to 2006, the Robert Wood Johnson Foundation (RWJF) funded 14 state-run projects under the Medicare/Medicaid Integration Program. RWJF separately funded a Minnesota project but considered it part of the program.

Key Results

• Three approaches for managing the care of dual eligibles emerged during the Medicare/Medicaid Integration Program: full integration, partial integration and managed fee-for-service. See Overall Program Results for a full description of each structural category.
• Massachusetts, Minnesota and Wisconsin launched or refined projects fully integrating Medicare and Medicaid financing and services for patients.
• Florida and Texas launched coordination efforts in which staff at managed care organizations coordinated Medicare/Medicaid acute and long-term patient care.
• Maine and Vermont experimented with managed fee-for-service projects with patient care coordinated by primary physicians' staff or state case managers working at their offices.
• Staff of the Medicare/Medicaid Integration Program helped states integrate their Medicare and Medicaid data, through advisory meetings with state project staffs, the use of consultants, a data users group and two technical assistance reports on data collection, use and integration.
• The program also helped build support for Medicare/Medicaid integration among staff at the federal Centers for Medicare & Medicaid Services (CMS) and in state governments, according to Program Director Mark R. Meiners, Ph.D., and RWJF Program Officer Nancy Barrand, M.P.A.

Key Findings

• A CMS-sponsored evaluation of 1998–2001 data from two projects — Minnesota Senior Health Options and the Wisconsin Partnership Program — indicated mixed enrollee outcomes at both initiatives.
• A subsequent analysis of the Wisconsin project showed improved outcomes, including:
  • The project's disabled enrollees spent fewer days as hospital inpatients than individuals in comparable groups outside the project.
  • Its elder enrollees spent fewer days in nursing homes than individuals in comparable groups.

Program Management
The University of Maryland Center on Aging in College Park, Md., housed the national program office. In late 2004, the office moved to George Mason University College of Nursing and Health Science in Fairfax, Va., with the program's director, Mark R. Meiners, Ph.D.

Funding
RWJF authorized the program for up to $8 million in July 1996.

Stories
This report contains stories of six low-income senior dual eligibles who benefited from Medicare/Medicaid Integration.

• Larry Wants to Take Care of Himself
• Estella's Macular Degeneration: A Story From Minnesota Senior Health Options
• Mae, Temporarily Too Weak After Surgery to Keep House or Eat Properly: A Story From the Wisconsin Partnership Program
• Story of an Elder Couple, Both Disabled: A Story From the Wisconsin Partnership Program
• John Gets Back to His Life: A Story From MassHealth Senior Care Options
• Manual's Alzheimer's: A Story From MassHealth Senior Care Options