The Revised CMS “Look-Alike” Termination Policy Falls Short Of Integrating Care For Dual-Eligible Beneficiaries Yanlei Ma Jessica Phelan Eric T. Roberts Kenton J. Johnston José F. Figueroa

https://www.healthaffairs.org/content/forefront/revised-cms-look-alike-termination-policy-falls-short-integrating-care-dual-eligible Integrating Medicare and Medicaid benefits for dual-eligible beneficiaries remains a national and state priority. Currently, the main strategy employed by policy makers to advance this goal has been shifting dual-eligible enrollment from non-integrated plans into highly integrated care plans in which one single entity coordinates Medicare and Medicaid services and assumes full financial responsibility across both programs. Dual Eligible Special Needs Plans (D-SNPs), a type of Medicare Advantage (MA) plan that exclusively enrolls dual-eligible beneficiaries, have emerged as the leading platform for integrated care, with a subset of D-SNPs attaining substantial financial integration with Medicaid.