Tip Sheet

This tip sheet is designed to help states that are planning procurements related to their integrated care programs for dually eligible individuals. It aims to help these states: (1) understand the relationship between state efforts to procure Medicaid managed care plans for these programs and the state’s D-SNP contracting strategy; (2) consider

This tip sheet details strategies states can use in their State Medicaid Agency Contracts (SMACs) with Dual Eligible Special Needs Plans (D-SNPs) to promote integration and coordination of behavioral health benefits among enrolled dually eligible individuals. This tip sheet also highlights how a few D-SNPs have gone beyond the SMAC requirements to further promote behavioral health integration.

Integrating Dual Eligible Special Needs Plan Materials to Promote Enrollee Understanding of and Access to Benefits

Dual Eligible Special Needs Plans (D-SNPs) that operate with exclusively aligned enrollment and cover Medicaid benefits through the D-SNP or an affiliated Medicaid managed care plan – classified as applicable integrated plans (AIPs) – can provide their enrollees with a single set of fully integrated materials that describe both the Medicare and Medicaid benefits covered by the D-SNP (and its affiliated Medicaid plan, when applicable). 

This tip sheet describes the Medicare resources available to states to monitor Dual Eligible Special Needs Plan (D-SNP) performance, explains how states can leverage those resources for Medicaid managed care quality oversight and improvement, and provides tips for states on incorporating D-SNPs into Medicaid quality improvement activities.

 

This tip sheet summarizes four key policy decisions for states preparing to implement EAE, as well as four factors that states may wish to consider when making those policy decisions. 

This tip sheet provides a brief overview of exclusively aligned enrollment, as well as a summary of the benefits of EAE for dual eligible special needs plan (D-SNP) enrollees, providers, and states.

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.

 

This resource was updated in June 2023 to correct an error in the definition of applicable integrated plan in the previous version.

ICRC has developed a basic fact sheet on individuals who are dually eligible for Medicare and Medicaid.