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States seeking to integrate Medicare and Medicaid services for dually eligible beneficiaries need to consider a variety of issues in program design and implementation such as incorporating behavioral health and long-term services and supports, consumers and providers engagement, and linking Medicare and Medicaid data. Use the filter below to view resources related to these and other topics.

Viewing 1 - 15 of 18

Technical Assistance Tool | September 2026
Unified Appeal and Grievance Processes for States with Applicable Integrated Plans (AIPs)
CMS requires D-SNPs that qualify as AIPs—meaning they operate with exclusively aligned enrollment and cover certain Medicaid benefits through the D-SNP or the D-SNP’s affiliated Medicaid managed care plan—to use unified appeal and grievance… (Integrated Care Resource Center)
Tip Sheet | May 2023
Tips to Help States Select Medicaid Managed Care Authorities as They Design Integrated Care Initiatives for Dually Eligible Individuals
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… (Integrated Care Resource Center)
Technical Assistance Tool | July 2022
Appeals and Grievances: Comparisons of Existing and New Integrated Processes for Individuals Enrolled in Applicable Integrated Plans
Beginning in 2021, Dual Eligible Special Needs Plans (D-SNPs) with exclusively aligned enrollment must begin using integrated appeals and grievance processes. The flowcharts in this resource are designed to help states, health plans, and… (Integrated Care Resource Center)
Technical Assistance Tool | December 2021
Fillable Tables for States Assessing the Fiscal Viability of a Medicare 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… (Integrated Care Resource Center)
Technical Assistance Tool | December 2021
Assessing the Fiscal Viability of a Medicare Part A Buy-in Agreement in Group Payer States
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… (Integrated Care Resource Center)
Other Resource | November 2020
Contract Year (CY) 2021 Notices for Applicable Integrated Plans
Please see the attached memorandum entitled "Contract Year (CY) 2021 Notices for Applicable Integrated Plans: “Coverage Decision Letter”, “Letter about Your Right to Make a Fast Complaint” and “Appeal Decision Letter”" from Sharon Donovan, Director,… (Centers for Medicare & Medicaid Services)
Other Resource | May 2020
Contract Year 2021 Models for Applicable Integrated Plans: 'Letter about Your Right to Make a Fast Complaint' and 'Appeal Decision Letter'
This CMS memorandum describes the final Contract Year 2021 model notices for Dual Eligible Special Needs Plans that are applicable integrated plans, "Letter about Your Right to Make a Fast Complaint" and "Appeal Decision Letter", which are both… (Centers for Medicare & Medicaid Services)
Other Resource | March 2020
Information for PACE Organizations Regarding Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19)
This memo provides information to PACE organizations to help control and prevent the spread of the virus to causes COVID-19. (Centers for Medicare & Medicaid Services)
Other Resource | May 2019
Medicare and Medicaid Programs; Programs of All-Inclusive Care for the Elderly (PACE)
This Centers for Medicare & Medicaid Services (CMS) final rule strengthens patient protections, improves care coordination, and provides administrative flexibilities and regulatory relief for Programs of All-Inclusive Care for the… (Centers for Medicare & Medicaid Services)
Brief | November 2018
Building a Stronger Foundation for Medicare- Medicaid Integration: Opportunities in Modifying State Administrative Processes
This brief describes several administrative changes that state Medicaid programs can make to: (1) support integration efforts; (2) improve beneficiaries’ experience of care; (3) decrease beneficiary out-of-pocket costs; and (4) reduce provider… (Integrated Care Resource Center)
September 2017
State and National Profiles of Medicare-Medicaid Enrollees
These profiles provide demographic, enrollment, and expenditure data for Medicare-Medicaid Enrollees. See the data reports for additional details: National Summary 2012 | National Data File 2012 | State and County Data File 2012 | National and… (Centers for Medicare & Medicaid Services)
May 2015
Report to Congress: The Centers for Medicare & Medicaid Services' Evaluation of For-Profit PACE Programs under Section 4804(b) of the Balanced Budget Act of 1997
This report presents information on the frailty level, access to care, and the quality of care of PACE participants enrolled with for-profit PACE organizations as compared to not-for-profit PACE organizations and is based on the <a href=… (Centers for Medicare & Medicaid Services)
March 2015
Effect of PACE on Costs, Nursing Home Admissions, and Mortality: 2006-2011
This report examines the effects of PACE on Medicare and Medicaid expenditures, use of nursing facility use, and mortality. (Assistant Secretary for Planning and Evaluation)
March 2014
Strategies for Incorporating PACE into State Integrated Care Initiatives: A Toolkit for States
This toolkit suggests strategies for states to incorporate PACE into their broader integrated care strategies. (National PACE Association)
January 2014
Evaluating PACE: A Review of the Literature
This report uses existing evaluations of PACE to summarize the available evidence on the effect of PACE on: Medicare and Medicaid costs; hospital and nursing facility use; quality of care, satisfaction and quality of life; and mortality. (Assistant Secretary for Planning and Evaluation)