Innovative Approaches to Stratification and Rate Setting

Stratifying Medicare-Medicaid enrollees by their level of need may help states and health plans prioritize and promptly address the care management needs of these individuals in order to ensure high-quality, timely care. This brief from the Center for Health Care Strategies describes how three states - California, Ohio, and Virginia - are accomplishing this work.

Dual Eligibles, CA State Budget and Policy, Federal Budget and Policy

Individuals eligible for both Medicare and Medicaid are among the highest-need populations in either program. States integrating care for this population must ensure that individuals’ health and social service support needs are addressed promptly. Stratifying Medicare-Medicaid enrollees by their level of need may help states and health plans in better prioritizing and promptly addressing care management to ensure high-quality, timely care. This brief describes how three states – California, Ohio, and Virginia – are requiring integrated health plans to stratify Medicare-Medicaid enrollees by their level of need within new capitated financial alignment demonstrations.