Medicare-Medicaid Plan (MMP) Enrollment

States participating in the capitated model demonstrations are required to follow the below National MMP Enrollment Guidance & Exhibits, as well as utilize the enrollment resources listed, to ensure individuals have full access to seamless, high quality integrated health care. Note that in almost all cases the state Medicaid agency and enrollment broker administer enrollment processes.

• National Enrollment/Disenrollment Guidance for States & MMPs (released 08/02/2018; effective 01/01/2019) (PDF)

Enrollment Technical Resources & Related Enrollment Guidance

• MMP Eligibility & Enrollment Transaction Processing Technical Guide Version 3.3
• Medicare Advantage and Prescription Drug Plan Communications User Guide (PCUG) Manual (revised quarterly)
• Electronic Retroactive Processing Transmission (eRPT) Training for MMPs
• Enrollment Data Validation (EDV) process for States and MMPs (04/25/2014) (PDF)
• MMP Monthly Enrollment Payment Data Guidance (06/14/2014) (PDF)
• Integrated Care Resource Center (ICRC) technical enrollment webinars
• ICRC: MMP Enrollment Processing Updates resulting from the Comprehensive Addiction and Recovery Act of 2016 (CARA)

Enrollment & Disenrollment Memos

• Coordinating Passive Enrollment with Medicare Reassignment for January 2021 (PDF)
• Clarification of Medicaid Provider Enrollment Provisions for Services Provided by Integrated D-SNPs & MMPs (04/22/2019) (PDF)
• Memo to Long Term Care Facilities on Disenrollment Issues (05/26/2015) (PDF)

Training Resources on Enrollment Processing

• MMP Enrollment Processing: Training Resources

Appendix 5 is a state-specific document that contains a state's detailed description of policies related to enrollment, as well as Medicaid-specific requirements and functions.

MMP Enrollment Guidance Appendix 5

Appendix 5 is a state-specific document that contains a state's detailed description of policies related to enrollment, as well as Medicaid-specific requirements and functions.

• California (PDF)
• Illinois (PDF)
• Massachusetts (PDF)
• Michigan (PDF)
• New York FIDA (PDF) (demonstration ended 12/31/2019)
• New York FIDA-IDD (PDF)
• Ohio (PDF)
• Rhode Island (PDF)
• South Carolina (PDF)
• Texas (PDF)
• Virginia (PDF) (demonstration ended 12/31/2017)