The Medicare-Medicaid Alignment Initiative (MMAI) is a specialized health program designed to improve the complex healthcare experience for individuals enrolled in both Medicare and Medicaid, often referred to as “dual-eligibles.” This initiative directly addresses the fragmentation of care and administrative burdens that arise when two separate federal and state programs cover the same person. The goal of MMAI is to integrate the financing and delivery of health services to create a more streamlined system of care.
Defining Medicare-Medicaid Alignment Initiatives (MMAI)
The structural foundation for MMAI was established following the passage of the Affordable Care Act (ACA), which created the Medicare-Medicaid Coordination Office (MMCO) within the Centers for Medicare & Medicaid Services (CMS). The MMCO was tasked with developing new models to align and coordinate benefits and payments between the two distinct programs. The MMAI is the resulting framework, operating as a demonstration project developed collaboratively between CMS and specific states, such as Illinois, California, and Michigan.
This initiative is not a single insurance company but a policy approach that allows for the creation of Medicare-Medicaid Plans (MMPs) through managed care organizations. These MMPs are private health plans that contract with both CMS and the state to provide all covered services under one umbrella. The framework tests whether integrated care management can lead to better health outcomes and a more efficient use of public funds for this vulnerable population.
Eligibility Criteria for MMAI Plans
Eligibility for MMAI plans requires meeting the requirements for both Medicare and Medicaid, establishing “dual eligibility.” An individual must be entitled to Medicare, typically meaning being 65 or older or under 65 with certain disabilities. They must be enrolled in Medicare Part A (hospital insurance), Part B (medical insurance), and Part D (prescription drug coverage).
The second requirement is full Medicaid enrollment, which is based on meeting strict income and asset limits that vary by state. For example, applicants must often meet the financial qualifications for categories like Aid to the Aged, Blind, and Disabled (AABD). Specific financial limits, such as an income limit set around 100% of the Federal Poverty Level and a strict asset test, must be satisfied to receive full Medicaid benefits.
Integrated Benefits and Coordinated Care
The core value proposition of MMAI is the comprehensive unification of services that were previously managed separately by Medicare and Medicaid. Under a Medicare-Medicaid Plan, a member receives all Medicare services, including hospital care, physician visits, and prescription drug coverage (Part D), alongside their full Medicaid benefits. Medicaid coverage includes services such as long-term services and supports (LTSS), behavioral health services, non-emergency medical transportation, and supplemental dental or vision care.
This integration simplifies the process for the beneficiary by providing a single identification card for all covered services, eliminating the need to navigate two separate systems. MMAI plans mandate the assignment of a dedicated care coordinator or care team for each member. This coordinator acts as a single point of contact responsible for managing the member’s medical, behavioral, and long-term care needs. The coordinator develops a personalized care plan, facilitates communication between providers, and ensures seamless transitions across various care settings. This coordinated approach aims to reduce medical errors and prevent unnecessary hospitalizations.
Enrollment Process and State-Specific Availability
MMAI is implemented as a demonstration project, meaning the plans are not available nationwide but are limited to specific states and service areas. Availability is often restricted to certain counties within those states. Prospective members must first confirm that the MMAI program operates in their specific geographic region before proceeding with enrollment.
The enrollment process typically offers eligible beneficiaries the option to voluntarily choose an MMAI plan. In some participating counties, individuals are subject to “passive enrollment,” where they are automatically assigned to a plan if they do not actively choose one or opt out. Beneficiaries always retain the right to disenroll and return to traditional Medicare and Medicaid fee-for-service coverage at any time, usually on a monthly basis. To enroll or get detailed information, individuals must contact their state’s Medicaid enrollment broker or the state’s Department of Healthcare and Family Services.