Strengthening State Capacity in Care for Dually Eligible Individuals

A Year of Advancement

In 2024, Altarum Medicare-Medicaid Services for States (AMMS) made tremendous progress. We continued to support states in their efforts to improve the care quality and cost efficiency of services for those who are dually eligible for Medicaid and Medicare. Building on past success, we focused our efforts on developing and administering strategies that advance health, wellness, independent living, and effective, efficient program oversight. 

Our experts led states to significant improvements in program advancement and efficiency for this diverse population. By adopting a flexible approach, we met states where they were in their journey to improving programs, offering tailored guidance and support to help them advance their initiatives.

Our Impact in Maine

In partnership with the Maine Department of Health and Human Services, the Maine Office on Aging and Disability Services, and the Office of MaineCare Services, AMMS supported efforts to enhance their existing programs for dually eligible individuals. 

Our team provided critical expertise to improve the state’s understanding and use of Medicare and Medicaid data, enabling more effective program oversight and integration.

To support these efforts, we:

  • Developed a comprehensive data chart pack that outlined population characteristics and service utilization patterns,
  • Conducted a SWOT analysis (strengths, weaknesses, opportunities, and threats), which identified areas for improvement in Medicaid programs—particularly in long term services and supports,
  • Highlighted strategies to ensure Medicaid remains the payer of last resort, optimizing funding and resource allocation, and
  • Explored coordination opportunities between Medicaid and Medicare to enhance efficiency and care delivery.

Drawing on these insights, we worked with the state to design a multi-year roadmap with actionable steps to improve services for dually eligible individuals. This roadmap reflects state priorities and provides a structured approach to enhancing Medicaid and Medicare program coordination in Maine.

Our Impact in Michigan

In collaboration with the Michigan Public Health Institute and the Michigan Department of Health & Human Services, AMMS supported the transition from a demonstration program to a new permanent statewide Medicare-Medicaid integration initiative. This effort resulted in successful procurement of a Medicare Advantage highly integrated dual eligible special needs plan (HIDE SNP) program, designed to improve care for dually eligible individuals.

To support this transition, we provided: 

  • Project management to ensure a seamless implementation process,
  • Policy and program design support to align the initiative with state and federal guidelines,
  • Development of the HIDE SNP request for proposals to establish competitive program standards, and
  • A model contract for the program.

We also offered leadership support and on-the-ground team assistance, facilitating strategic decision-making and fostering transparent communication. 

The project led to the successful release of the request for proposal, with effective timeline management, resource coordination, risk mitigation, and post-release support, ensuring a smooth and effective proposal process.

Our Impact in Tennessee

AMMS partnered with Tennessee to enhance care quality, improve service experience, and increase cost efficiency for full-benefit dually eligible individuals. Through the Quality and Enrollment in Aligned Dual Eligible Special Needs Plans (D-SNPs) Project, we continue to provide hands-on expertise, staff augmentation, and training to support state-led efforts.

Key activities include the following:

  • Defining integration goals: Assisting Tennessee in refining its dual integration program goals and identifying policies and program options to support these efforts.
  • Enhancing quality measures: Collaborating with TennCare (the state’s Medicaid managed long term services and supports (MLTSS) program) to develop whole-person quality metrics across Medicare and Medicaid, linked to incentive structures.
  • Strengthening SMAC provisions: Supporting the drafting of state Medicaid agency contract (SMAC) provisions to better align D-SNP benefits with integrated care goals and Medicaid cost-saving strategies.

AMMS works as an extension of the TennCare D-SNP team. We mentor staff and provide training to build internal capacity for dually eligible program development, oversight, improvement and integration. This collaborative approach ensures sustainable improvements in Tennessee’s ability to manage and advance its integrated care efforts.

Focus Areas

Medicare and Medicaid

Looking Ahead

Our work sheds light on the complexities and value of meeting states where they are to advance programs of better quality, cost effectiveness, and more coordinated and integrated services and administration across Medicaid and Medicare, providing valuable insights and shaping the future of health care for dually eligible individuals. AMMS remains committed to supporting states at various stages of maturation and capacity by providing tailored solutions that address their unique needs and challenges. 

AMMS facilitates knowledge exchange and collaboration. We enable states to learn from each other’s successes and challenges, fostering innovation and enhancing the effectiveness of state programs across the country. Our dedication to being a voice of expertise in this complex space and across Medicaid ensures that we will remain at the forefront of advancing better and more coordinated, integrated care for individuals who are dually eligible, driving positive outcomes and enhancing the quality of care nationwide.

Michigan Medicaid would not be where we are today in our transition to a permanent [HIDE SNP] program with AMMS.

— Meghan Groen, MDHHS Medicaid Director

 

Focus Areas

Medicare and Medicaid