Closing the Coverage Coordination Gap for Dual Eligibles

July 27, 2021

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Persons dually eligible for Medicare and Medicaid are among the highest need populations in either program. However, a lack of coordination between these programs makes it difficult for individuals enrolled in both to navigate between the two, and adds to the overall cost of both programs. Given that dual eligible beneficiaries are more likely to have complex clinical care needs and lower incomes, this population needs a different level of services and supports than the general Medicare beneficiary population.

This briefing provided a brief landscape of the dual eligible population and the challenges they face when seeking comprehensive coverage and care. Attendees learned about the spectrum of integration of the Medicare and Medicaid programs on behalf of this population, and defined what success looks like in an integrated plan.


  • Sarah Barth, J.D., Principal, Health Management Associates
  • Denny Chan, J.D., Directing Attorney, Equity Advocacy, Justice in Aging
  • Allison Rizer, MHS, MBA, Principal, ATI Advisory
  • Sarah J. Dash, MPH, President and CEO, Alliance for Health Policy (moderator)

This event was made possible with support from Arnold Ventures.

Presentation: Closing the Coverage Coordination Gap for Dual Eligibles

Event Resources

Key Resources

(listed chronologically, beginning with the most recent)

“Why Aren’t Value-Based Payment Models More Successful? A Failure to Confront Market Dynamics.” Pham, H., Navathe, A. Health Affairs. January 27, 2022. Available here.

“The Case for ACOs: Why Payment Reform Remains Necessary.” Chernew, M., McWilliams, J. Health Affairs. January 24, 2022. Available here.

“Building on The CMS Strategic Vision: Working Together for a Stronger Medicare.” Seshamani, M., Fowler, E., Brooks-LaSure, C. Health Affairs. January 11, 2022. Available here.

“Health Policy Handbook, Chapter 6: Dual Eligible Beneficiaries.” Rawal, P., Whitlock, R. Alliance for Health Policy. July 20, 2021. Available at

“More Research is Essential to Improve Care for Dual-Eligible Beneficiaries.” Mir, A. Arnold Ventures. July 6, 2021. Available at

“Chapter 4: Establishing a Unified Program for Dually Eligible Beneficiaries: Design Considerations.” MACPAC. March 2021. Available at

“Dually Eligible Individuals – Categories.” Centers for Medicare and Medicaid Services. 2021. Available at

“COVID-19’s Effect on Dually Eligible Populations.” Archibald, N., Soper, M. Center for Health Care Strategies. November 2, 2020. Available at

“Integrating Care for Dually Eligible Beneficiaries: Background and Context.”  MACPAC. June 2020. Available at

“People Dually Eligible for Medicare and Medicaid Fact Sheet.” Centers for Medicare and Medicaid Services Medicare-Medicaid Coordination Office. March 2020. Available at

“Improving Care and Managing Costs for Dual Eligibles.” Johnson, K., Becker, M., Tewarson, H., et al. National Governors Association. February 2020. Available at

Additional Resources

(listed chronologically, beginning with the most recent)

“D-SNPs: Integration & Unified Appeals & Grievance.” Centers for Medicare and Medicaid Services. June 24, 2021. Available at

“COVID-19 Shows Now Is the Time To Integrate Care for Dual-Eligible Beneficiaries.” Leavitt, M. Health Affairs Blog. February 17, 2021. Available at

“Managed Long-Term Services and Supports.” MACPAC. November 2020. Available at

“Integrated Care Programs for Dually Eligible Individuals in the Era of COVID-19: Response Efforts and Policy Recommendations.” Janoski, B., Betlach, T., Soper, M. Center for Healthcare Strategies. October 2020. Available at

“The Next Step in Medicare Reform.” Miller, B., Wilensky, G. Backgrounder. The Heritage Foundation. September 16, 2020. Available at

“Evaluations of Integrated Care Models for Dually Eligible Beneficiaries: Key Findings and Research Gaps.” MACPAC. August 2020. Available at

“Medicare-Medicaid Integration: Reflecting on Progress to Date and Charting the Path to Making Integrated Programs Available to all Dually Eligible Individuals.” Barth, S., Blum, J., Henry, E., et al. Health Management Associates. August 2020. Available at

“A Pathway to Full Integration of Care for Medicare-Medicaid Beneficiaries.” Hayes, K, Hoagland, W., Harootunian, L., et al. Bipartisan Policy Center. July 27, 2020. Available at

“Integrating Care for Dually Eligible Beneficiaries: Policy Issues and Options.” MACPAC. June 2020. Available at

“Medicare-Medicaid Integration: Integrated Model Enrollment Rates Show Majority of Medicare-Medicaid Dual Eligible Population Not Enrolled.” Barth, S., Blum, J., Breslin, E., et al. Health Management Associates. April 2020. Available at

“Additional Guidance on CY 2021 Medicare-Medicaid Integration Requirements for Dual Eligible Special Needs Plans (D-SNPs). Donovan, S. Centers for Medicare and Medicaid Services. January 17, 2020. Available at

“Arnold Ventures Dual Eligible Fact Sheet.” Arnold Ventures. 2020. Available at

“Integrating Care Through Dual Eligible Special Needs Plans (D-SNPS): Opportunities and Challenges.” Archibald, N., Soper, M., Smith, L., et al. U.S. Department of Health and Human Services. April 8, 2019. Available at

“Data Book: Beneficiaries Dually Eligible for Medicare and Medicaid.” MedPAC and MACPAC. January 2018. Available at




Sarah Barth, J.D.
Health Management Associates, Principal

Denny Chan, J.D.
Justice in Aging, Directing Attorney

Allison Rizer, MBA
ATI Advisory, Principal

Experts and Analysts

Nancy Archibald, MHA, MBA
Center for Health Care Strategies, Associate Director, Integrated Care, Federal Programs

Tom Betlach, MPA
Speire Healthcare Strategies, Partner

James Capretta, MPP
American Enterprise Institute, Resident Fellow and Milton Friedman Chair

Katherine Hayes, J.D.
Bipartisan Policy Center, Director of Health Policy

Cindy Mann, J.D.
Manatt, Phelps & Phillips, LLP, Partner

Vincent Mor, Ph.D.
Brown University School of Public Health, Florence Pirce Grant Professor of Community Health

Michelle H. Soper, MHS
Center for Health Care Strategies, Inc., Director, Integrated Care

Elizabeth Wood, MPAP
Mathematica, Health Researcher


Nina Ashford, DrPH, MPH
Medicare-Medicaid Coordination Office at Centers for Medicare & Medicaid Services, Deputy Director of Program Alignment

Caleb Graff, M.A.
Senate Committee on Finance, Senior Health Policy Adviser

Marc Steinberg, J.D., MPP
Medicare-Medicaid Coordination Office at Centers for Medicare & Medicaid Services, Technical Director

Arrah Tabe-Bedward, J.D., M.S.
Center for Medicare and Medicaid Innovation, Deputy Director


Jean Accius, Ph.D.
AARP, Senior Vice President, Global Thought Leadership

Melanie Bella, MBA
Cityblock Health, Chief of New Business and Policy

Travis Broome, MPH, MBA
Aledade, Inc., Senior Vice President for Policy and Economics

Matt Eyles, M.S.
America’s Health Insurance Plans, President and CEO

Lynda Flowers, J.D., MSN, R.N.
AARP, Senior Strategy Policy Advisor, Public Policy Institute

Tim Gronniger, MPP, MHSA
Caravan Health, Chief Executive Officer

Andy Imparato, J.D.
Disability Rights California, Executive Director

Bill Kramer, MBA
Purchaser Business Group on Health, Executive Director for Health Policy

Sachin Jain, M.D., MBA
SCAN Health Plan, President and CEO

Anne Montgomery, M.S.
Altarum, Co-Director, Program to Improve Eldercare

Hemi Tewarson, J.D., MPH
National Academy for State Health Policy, President and CEO



This is an unedited transcript.