March, 2006

State Guide to Integrated Medicare & Medicaid Models - DRAFT

"The purpose of this guide is to outline options that States may wish to consider when developing new Medicaid managed care contracts for dual-eligible beneficiaries. The guide is a tool for State personnel already involved in serving dual eligible beneficiaries. The guide is a starting point, a working document, which CMS hopes will stimulate improved performance and better value for serving dual eligibles through the creation of integrated service delivery systems for Medicare and Medicaid benefits, subject to the current statutory and regulatory environment in which each program operates ... The guide was also developed to promote a regulatory environment that is conducive to integrating services provided by MA Organizations and Medicaid. The intent is to convey the possibilities of an integrated program that works within existing or proposed regulations, is valuable to dual-eligible beneficiaries, meets State Medicaid Plan objectives, and is marketable for MA Organizations. The objective is to outline the considerations of implementing an integrated Medicare/Medicaid environment to the extent possible under the existing and regulatory environment. Moreover, this guide aims to stimulate thought on the possibilities of efficacious, integrated Medicare/Medicaid plans for dual eligibles that meet the needs of States and MA Organizations."