More than one in 10 individuals who are dually eligible for Medicare and Medicaid have an intellectual disability or a related condition, such as a developmental disability, and up to half of all individuals served by state intellectual and developmental disabilities (I/DD) systems are dually eligible. Despite this, the design, implementation, and evaluation of models of care that integrate comprehensive Medicare and Medicaid services for dual eligibles rarely consider the particular needs of people with I/DD, or common challenges they face in addressing those needs.

Instead, most states have taken a one-size-fits-all (or one-size-fits-most) approach to designing integrated care models for their dually eligible populations. This lack of inclusive policy making and program design suggests that existing integrated care models are not meeting the needs of people with I/DD who enroll in those programs, as many advocates in the I/DD community have argued. In fact, a 2022 Health Affairs article on integrating care for dual eligibles with I/DD noted that most state Medicaid agency contracts “lack mention of individuals with I/DD altogether as a subpopulation, instead focusing on older adults and individuals with physical disabilities.”

Integrated Care Models Have Not Considered The Needs Of People With I/DD

A core goal of integrated care is to bridge the service continuums and align performance incentives of Medicare and Medicaid programs. Most integrated care models do this through varying levels of coordination, or by bringing all services under a single entity, or some combination of both. For dual eligibles with I/DD, Medicare and Medicaid fund these individuals’ physical and behavioral health services, but those individuals often rely on a third system for a broad range of disability-related and social support services. These I/DD systems are primarily Medicaid-funded but have specialized vendor and provider networks for I/DD-related services and supports as well as have deep expertise in person-centered service coordination and support navigation for I/DD populations. However, integrated care models for dual eligibles with I/DD have not focused on aligning physical health, behavioral health, and I/DD services across these systems to meet the needs of the individuals those models are meant to serve.

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