Document Type

Policy Brief

Publication Date



Integrated care, rural, models, organizational, MRHRC, population health, USM Aging Initiative, Health and Wellness


Recognizing that traditional models of health care delivery and payment often produce fragmented and costly care and poor outcomes for those with the highest needs, many reforms under the Affordable Care Act (ACA) focus on realigning payment incentives and integrating care. These reforms presuppose the existence of supporting infrastructure and capacity, including dedicated care management staffing and health information technology and exchange. With a focus on community-dwelling older adults in need of integrated physical, behavioral health services, and long term services and supports (LTSS), this brief reviews the opportunities and challenges these reform initiatives present for rural communities: How easily can current models for integrating care be adapted to a rural context and culture? How well do they account for gaps and variations in local delivery systems, capacity, and infrastructure? Which strategies offer the greatest promise for addressing the needs of rural residents? Because Medicaid is a primary source of funding for LTSS, we focus this inquiry on models serving Medicaid-eligible individuals; in some cases these programs may also serve individuals who are also eligible for Medicare.

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