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 this glossary, ICRC highlights key terms related to dually eligible individuals and the Medicare and Medicaid integrated care programs that serve them. In many instances, we have paraphrased definitions from federal regulatory language and simplified them for ease of use and understanding. Therefore, the definitions offered in this document may vary slightly from the precise legal definitions issued in statute, regulation, or sub-regulatory guidance.