Mathematica Responds to Congressional RFI on Integrated Care and Dually Eligible Individuals

Mathematica Responds to Congressional RFI on Integrated Care and Dually Eligible Individuals

Jan 17, 2023

Mathematica responded on January 13 to a request for information (RFI) from U.S. Senators Bill Cassidy, M.D., Thomas R. Carper, Tim Scott, Mark R. Warner, John Cornyn, and Robert Menendez regarding improving coverage and care for those dually eligible for Medicare and Medicaid.

Mathematica’s response highlighted the organization’s work on a variety of research and technical assistance projects related to dually eligible individuals under contracts with the Centers for Medicare & Medicaid Services (CMS), the Medicaid and CHIP Payment and Access Commission (MACPAC), individual states, and foundations. It also emphasized Mathematica’s extensive knowledge of Medicaid and Medicare policies, programs, and related data sources, all of which are relevant to designing, implementing, and evaluating integrated care models for dually eligible individuals.

Mathematica’s response focused on:

  • Defining and distinguishing integrated care, care coordination, and aligned enrollment in the context of care for dually eligible beneficiaries;
  • Examining which models have worked particularly well at integrating care for dually eligible individuals, whether on the state level, federal level, or both;
  • Recommendations around building upon current systems in place versus starting from scratch with a new, unified system;
  • Coverage strategies for “partial-” vs. “full-” benefit dually eligible individuals when it comes to improving outcomes;
  • Policies and practices that support enrollment retention in integrated care plans; and
  • Geography’s role in coverage and care management strategies for this population.

Additionally, Mathematica provided four additional suggestions regarding areas for further study that the organization hopes will also be of interest to the Senate as it considers options for improving care for dually eligible individuals:

  • The ways in which Medicare and Medicaid benefit eligibility churn may impact or interact with efforts to integrate Medicare and Medicaid benefits for dually eligible populations;
  • The impact of Financial Alignment Initiative demonstration close-out and transition processes for dually eligible enrollees;
  • The extent to which transitions from partial-benefit to full-benefit dual eligibility status affects patterns of health care utilization and whether integrated care plans may offer any benefit during those transitions; and
  • Options for improving the collection and quality of the Medicaid administrative data needed to perform these kinds of analyses.