Medicaid-Medicare Integration for a High Cost, High Need Era

Millions of Americans are losing coverage as emergency protections end with dual-eligible beneficiaries bearing the greatest risk. Forced to navigate two separate programs with different rules, formularies, provider networks and payment models, this already vulnerable population is experiencing fragmentations that drive higher costs, poorer outcomes, and administrative burden for both clinicians and plans alike. The good news? New technology-enabled care models are showing promise in managing complex populations, while Special Needs Plans continue evolving to better serve their members. As policymakers search for the right balance between necessary oversight and the flexibility needed for innovation, explore what’s next for dual-eligible care as public insurance programs undergo their most significant transformation in years.