Introduction to Exclusively Aligned Enrollment

Many people who are dually eligible for Medicare and Medicaid report experiencing fragmented care that is poorly coordinated between these two complex payments systems. This is an issue of growing concern to many states and the Centers for Medicare & Medicaid Services (CMS), as dually eligible individuals tend to have more chronic, complex health needs and require more expensive care than people who are not dually eligible. For example, 46 percent of dually eligible individuals report having difficulty with at least one activity of daily living and 49 percent of full-benefit dually eligible individuals use long-term services and supports (LTSS). Additionally, 35 percent of dually eligible individuals live alone and 34 percent do not have a high school diploma – social risk factors that, coupled with the need to navigate two separate and siloed payment systems, can create significant barriers to care. To offer a more coordinated and holistic system of coverage for this population, CMS and states are increasingly seeking to develop programs that offer integrated Medicare and Medicaid benefits. To achieve the fullest level of integration of Medicare and Medicaid benefits in programs that leverage Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs), states can use a policy strategy known as “exclusively aligned enrollment” (EAE).

This tip sheet provides a brief overview of exclusively aligned enrollment (EAE) as well as a summary of the benefits of EAE for dual eligible special needs plan (D-SNP) enrollees, providers, and states.