Opportunities for States
NEW! Guidance for States Seeking to Leverage New Opportunities for Integrated Care Programs
The Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs Rule codified a new pathway at 42 CFR 422.107(e) through which states can use state Medicaid agency contracts to require that dual eligible special needs plans (D-SNPs) with exclusively aligned enrollment (a) establish contracts that only include one or more D-SNPs within a state, and (b) integrate certain materials and notices for enrollees. Choosing to pursue the opportunities under 42 CFR 422.107(e) would confer several benefits, such as enabling quality reporting and ratings specific to each D-SNP-only contract, improving beneficiary experiences by providing a more seamless description of coverage through integrated materials, and improving coordination between states and CMS on monitoring and oversight of D-SNPs. The memorandum linked below provides states with guidance on the process for working with CMS to establish D-SNP-only contracts and develop integrated materials.
Medicare Part D Low-Income Subsidy and Medicare Savings Programs Data
On November 1, 2021, we released an Informational Bulletin describing ways for states to help eligible individuals enroll in the Medicare Savings Programs (MSPs), making health care more accessible and affordable. There are 1.25 million people enrolled in full Medicare Part D Low Income Subsidy (LIS) programs who are not enrolled in an MSP, despite likely being eligible. We are releasing a complete state-by-state listing of number and percentage of LIS enrollees who are likely eligible for an MSP but are not enrolled. We encourage states to review this data and evaluate the impact of their current policies and procedures on MSP take-up among LIS enrollees.
State Medicaid Director Letter: Three New Opportunities to Test Innovative Models of Integrated Care for Individuals Dually Eligible for Medicare and Medicaid
On April 24, 2019, we released a State Medicaid Director letter inviting states to partner with CMS to test innovative approaches to better serve those who are dually eligible for Medicare and Medicaid. Approaches discussed in the State Medicaid Director letter include: integrating care through two options under the current Financial Alignment Initiative - the capitated financial alignment model and the managed fee-for-service model - and state-specific models that would give states additional flexibility.
State Medicaid Director Letter: Opportunities to Better Serve Dually Eligible Individuals
On December 19, 2018, we released a State Medicaid Director letter describing ten opportunities - none of which require complex demonstrations or Medicare waivers - to better serve individuals dually eligible for Medicare and Medicaid. These opportunities include utilizing new developments in managed care, using Medicare data to inform care coordination and program integrity initiatives, and reducing administrative burden for dually eligible individuals and the providers who serve them. A number of these opportunities are newly available to states through Medicare rulemaking or other CMS burden reduction efforts.