Foundational Steps

This tip sheet summarizes key considerations for states trying to decide which pathway to use to advance Medicare-Medicaid integration, and which Medicaid managed care authority(ies) might best support that pathway. Although the tip sheet presents two pathways for states to consider, ultimately, a state may develop an integrated care model that falls somewhere in between these options. The Centers for Medicare & Medicaid Services (CMS) and ICRC can help each state identify a strategy that best meets its needs.

 

States may execute a Medicare Part A buy-in agreement with the Centers for Medicare & Medicaid Services (CMS) to facilitate access to Medicare Part A and dual eligible status under the Qualified Medicare Beneficiary (QMB) eligibility group. This access is beneficial to individuals and could also reduce administrative burden and costs for providers and states. However, as of November 2021, fourteen states do not have a Part A buy-in agreement.

States may execute a Medicare Part A buy-in agreement with the Centers for Medicare & Medicaid Services (CMS) to facilitate access to Medicare Part A and dual eligible status under the Qualified Medicare Beneficiary (QMB) eligibility group. This access is beneficial to individuals and could also reduce administrative burden and costs for providers and states. However, as of November 2021, fourteen states do not have a Part A buy-in agreement.

 This analysis examines trends in enrollment and eligibility for Medicare-Medicaid enrollees.