Editing Medicare dual eligible (section)

== Efforts to integrate Medicare and Medicaid benefits ==
Dual-eligibles typically receive their Medicare and Medicaid benefits through each program separately. For Medicare benefits, beneficiaries may opt to enroll in Medicare's traditional [[fee-for-service]] (FFS) program or in a private Medicare Advantage (MA) plan (Medicare Part C), which is administered by a [[Managed Care Organization]] (MCO), under contract with the [[Centers for Medicare & Medicaid Services]] (CMS), the agency in the [[Department of Health and Human Services]] that administers the Medicare program and oversees state Medicaid programs. In addition, dual-eligibles may choose a type of MA plan called a dual-eligible [[special needs plan]] (D-SNP), which is designed to target the needs of this population. For Medicaid benefits, beneficiaries generally enroll in their state's Medicaid FFS program or a Medicaid managed care plan administered by an MCO under contract with the state.

Recently, Congress and CMS have placed greater emphasis on the coordination and integration of Medicare and Medicaid benefits for dual-eligible beneficiaries. For example, the [[Medicare Improvements for Patients and Providers Act of 2008]] required D-SNPs to contract with state Medicaid agencies to provide Medicaid benefits. More recently, the [[Affordable Care Act]] (ACA) established a type of D-SNP, referred to as a Fully Integrated Dual Eligible (FIDE) SNP, which—unlike other D-SNPs—is designed to integrate program benefits for dual-eligible beneficiaries through a single managed care organization, although payment is generally provided separately by each program. In 2011, CMS announced a financial alignment demonstration that is intended to further integrate the programs' services. CMS expects that the demonstration will decrease incentives for cost shifting and increase care coordination, resulting in improved care for beneficiaries and savings to Medicare and Medicaid.<ref name=":2" /> CMS projects that approximately 61 to 75 percent of savings will come from reductions in costly Medicare-covered services.<ref>Centers for Medicare & Medicaid Services, Joint Rate - Setting Process for the Capitated Financial Alignment Model (Baltimore, Md . : August 2013)</ref>