Working with Maine to Improve Programs for Dually Eligible Individuals

In partnership with Maine’s Department of Health and Human Services, Office of Aging and Disability Services and Office of MaineCare Services, Altarum Medicare-Medicaid Services for States (AMMS) helped to strengthen programs serving individuals eligible for Medicare and Medicaid.

Completed in 2025, this initiative provided Maine with new tools and strategies to further improve quality, oversight, and cost efficiency.

Challenge: Fragmentation and Oversight Capacity

Because Medicare and Medicaid operate separately, Maine, like other states, faced challenges coordinating care for dually eligible individuals. Limited data sharing made oversight difficult, leading to duplicative processes and care transition delays. For example, when someone moved from hospital to home care, providers often lacked timely access to both Medicare and Medicaid data, creating gaps in long-term services and supports (LTSS). Maine needed a clear understanding of program strengths and weaknesses and a roadmap to align systems, optimize resources, and improve outcomes. It turned to AMMS.

Solution: Strategies for Program Improvement

AMMS worked with Maine to develop a three-year roadmap grounded in comprehensive research and collaborative engagement to identify critical pain points and deliver targeted solutions. The team:

• Conducted a landscape analysis mapping demographics, service utilization, and enrollment trends, including fee-for-service and Medicare Advantage participation;
• Identified strengths, weaknesses, opportunities, and threats in Medicaid and LTSS programs;
• Engaged participants through interviews and forums to improve program design and oversight,
• Provided technical assistance on compliance oversight, contracting, benefit design, strategies to keep Medicaid the payer of last resort; and
• Trained state staff on Medicare data sources and how to use them with Medicaid data for program improvement.