Key Policy Decisions and Considerations for States Preparing for Exclusively Aligned Enrollment

Exclusively aligned enrollment (EAE) is a policy tool for states interested in offering fully integrated Medicare and Medicaid benefits to people who are dually eligible for Medicare and Medicaid under a model that leverages Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs). EAE occurs when a state limits D-SNP enrollment to full-benefit dually eligible individuals who receive their Medicaid benefits from the D-SNP or an affiliated Medicaid managed care plan offered by the same parent organization as the D-SNP. These requirements ensure that anyone who enrolls in the D-SNP is ultimately eligible for the same unified package of benefits and facilitate several important benefits for plan enrollees, providers, and states. The methods that individual states use to effectuate EAE vary, often based on unique environmental factors. Through interviews and discussions with states that have already implemented EAE and states that are planning to implement EAE in the future, Integrated Care Resource Center (ICRC) staff identified several key policy decisions and considerations that have helped states design successful EAE models across a variety of landscapes and circumstances. This tip sheet summarizes those key policy decisions and considerations to help states new to EAE develop an approach that will fit their unique circumstances.