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Aligning Medicare and Medicaid

CMS has a number of efforts to streamline and align a wide variety of Medicare and Medicaid regulations, policies, and operations. Our goal is to more effectively bring together the Medicare and Medicaid programs. Through these activities, we identify and address conflicting requirements, competing incentives, or gaps between the Medicare and Medicaid programs. We work with states, health care providers, advocates, caregivers, and beneficiaries to:

  • Reduce administrative burden;
  • Provide the tools and information needed by all stakeholders; and
  • Improve the customer experience with CMS.

So far, we've worked on a number of areas, including:

Coordinated Care

We keep expanding and updating many coordinated care options for beneficiaries.

Cost-Sharing

We're working to reduce inappropriate billing of Qualified Medicare Beneficiaries (QMBs) in three ways:

  1. Helping beneficiaries to be more aware and strengthening our support;
  2. Making rules for plans and providers clearer; and
  3. Promoting compliance with administrative reforms.

Enrollment

We keep finding ways to help those with Medicaid and Health Insurance Marketplace health care coverage move smoothly to Medicare coverage. We're also promoting options to make it easier for enrollees to become eligible for Medicare Savings Programs and other categories of Medicaid when they become eligible for Medicare.

Fee-for-Service Benefits

We work to align regulations and policies for home health, durable medical equipment, skilled nursing facilities, and skilled therapies benefits.

Appeals

We're working to better align Medicaid and Medicare managed care appeals, and to help enrollees better understand their appeal rights.

Quality

We've started filling gaps in quality measurement that we found in earlier work when we partnered with the National Quality Forum (NQF), the Administration for Community Living (ACL), and other stakeholder organizations.

Access to Care

We keep looking for more ways to better collect and distribute information about accessibility to help people make more informed decisions when they choose providers.

Alignment Initiative Archives

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