Helping states develop integrated programs for individuals who are dually eligible for Medicare and Medicaid
This resource was updated in June 2023 to correct an error in the definition of applicable integrated plan in the previous version.
In this informational discussion, speakers from the Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI) provided an overview of the Long-term Enhanced ACO Design (LEAD) Model and opportunities for state participation. LEAD includes a novel Medicare-Medicaid integration component that has not been tested in previous CMS ACO models and programs. Under this component, ACOs will be able to partner with plans and states to offer a more comprehensive, integrated approach to serving full-benefit dually eligible individuals with Original Medicare.
ICRC has developed a basic fact sheet on individuals who are dually eligible for Medicare and Medicaid.
The Integrated Care Resource Center (ICRC) uses a variety of terms related to integrated care for dually eligible individuals in our written products and webinars. ICRC broadly uses the term “integrated care” to describe systems in which Medicare and Medicaid program administrative requirements, financing, benefits, and/or care delivery are aligned. In general, in “integrated care” systems, Medicare and Medicaid services are coordinated and may be covered through a single entity or coordinating entities, such as through health plans, medical systems, and/or providers.
In 2017, there were 12 million individuals dually eligible for Medicare and Medicaid. This fact sheet provides information on their reasons for Medicare eligibility, costs of care, and enrollment in managed care as well as the proportion of these beneficiaries who receive their care through arrangements that integrate their Medicare and Medicaid benefits.