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Integrating Care

The Centers for Medicare & Medicaid Services (CMS) has several programs that encourage states to provide integrated care, a concept that provides the full array of Medicaid and Medicare benefits through a single delivery system in order to provide quality care for dual eligible enrollees, improve care coordination, and reduce administrative burdens. See more information on each program:

Find more information on Medicare and Medicaid Enrollees.

Development and Design

Guidance tools like the Integrated Care Roadmap (ZIP, 3.13 MB)  include:

  • "At-A-Glance" Guide to Medicaid Authorities Available to States for Integrated Programs
  • Medicaid and Medicare Authorities to Implement Long-Term Care Capitation Models
  • Integrated Care Program Design
  • Center for Health Care Strategies
  • Rate Setting and Risk Adjustment: A Checklist for States

Information regarding optional models for an integrated Medicaid and Medicare appeals process for special needs plans includes:

Medicare Advantage

Cost Sharing

Information regarding Medicaid's obligation to pay cost-sharing for individuals who are eligible for both Medicare and Medicaid and who are enrolled in Medicare Advantage Plans:

Additional Guidance on the Medicare Advantage Program and Special Needs Plans

The Medicare Managed Care Manual provides additional information and guidance on the Medicare Advantage Program. Additional information on Special Needs Plans.