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CMS Provides States with Strategies to Strengthen Medicare-Medicaid Integration

The Centers for Medicare and Medicaid Services (CMS) issued a letter last month highlighting the ways in which state Medicaid agencies can improve the integration of Medicare and Medicaid services without pursuing waivers or establishing demonstration programs. The letter describes 10 opportunities that states may pursue:

  1. Implementing contractual provisions between state Medicaid agencies and Dual Eligible Special Needs Plans (D-SNPs) that promote integration;
  2. Implementing default enrollment of Medicaid managed care beneficiaries into the D-SNP associated with their Medicaid managed care plan when they attain Medicare eligibility;
  3. Implementing passive enrollment into a comparable integrated Medicare-Medicaid plan for beneficiaries of a plan that is closing or contracting;
  4. Integrating care through Programs of All-Inclusive Care for the Elderly (PACE);
  5. Using new streamlined processes that enable states to obtain Medicare data;
  6. Exercising new authority to use Medicare data obtained from CMS for program integrity purposes, as well as care coordination functions;
  7. Frequent submission of files identifying all dual-eligible beneficiaries to CMS to ensure that they are enrolled in applicable programs;
  8. Exchanging Medicare Buy-In files with CMS more frequently to promote enrollment in programs that help dually eligible beneficiaries to pay Medicare premiums;
  9. Facilitating Medicare Part A buy-in through state buy-in agreements that enable direct enrollment in Part A at any time of year;
  10. Simplifying eligibility and enrollment of low-income Medicare beneficiaries in the Medicare Savings Program by aligning the Part D Low-Income Subsidy with Medicare Savings Program eligibility criteria.

New York State is already engaged in many of these initiatives and is considering implementing default and passive enrollment in integrated managed care plans, as previously reported here. A webinar on default enrollment is available here.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8838