Medicare Basics

State Medicaid staff working to advance integrated care for their dually eligible populations may find it helpful to learn more about Medicare and how Medicare’s rules, covered benefits, and administrative processes align with those of the Medicaid program.

Working with Medicare. ICRC offers the Working with Medicare webinar series to help orient state Medicaid staff to Medicare policy.

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• Medicare 101 and 201: Key Issues for States. This two-part webinar provides an overview of Medicare program features of interest to state staff working to integrate care for dually eligible individuals. (ICRC, March 2020)
  • Medicare 101: An Introduction to Medicare Benefits and the Roles of Medicare and Medicaid in Serving Dually Eligible Individuals
  • Medicare 201: Actions States Can Take to Improve Quality and Coordination of Care for Dually Eligible Individuals
• State Contracting with D-SNPs. This two-part webinar provides an overview of state strategies for contracting with D-SNPs to improve care coordination and Medicare-Medicaid alignment for dually eligible individuals. (ICRC, December 2022)
  • Introduction to D-SNPs and D-SNP Contracting Basics
  • Using D-SNPs to Integrate Care for Dually Eligible Individuals

• Coordination of Medicare and Medicaid Behavioral Health Benefits

  This webinar provides an overview of Medicare and Medicaid behavioral health benefits (including mental health and substance use disorder benefits) for dually eligible individuals and opportunities to improve coordination in integrated care programs. It includes a summary of the new Medicare Opioid Treatment Benefit and implications for state Medicaid programs, as well as information about state options for covering treatment services in Institutions for Mental Diseases. (ICRC, April 2020)

• Medicare and Medicaid Nursing Facility Benefits: The Basics and Options for Improved Coordination and Quality

  This webinar provides an overview of Medicare and Medicaid nursing facility benefits and spending, as well as facility payment systems and methods utilized by fee-for-service Medicare, fee-for-service Medicaid, and managed care health plans. (ICRC, May 2018)

Other Medicare Resources. ICRC also has other resources that explain basic Medicare concepts for states.

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• Medicare Basics: An Overview for States Seeking to Integrate Care for Medicare-Medicaid Enrollees

  This brief is designed to help states better structure and coordinate the Medicaid benefits they offer to Medicare-Medicaid enrollees by providing them with basic information on the Medicare program, the services it covers, and the process used to set rates. (ICRC, June 2017)

• Glossary of Terms Related to Integrated Care for Dually Eligible Individuals

  This resource highlights key terms related to dually eligible individuals and the Medicare and Medicaid integrated care programs that serve them. (ICRC, March 2021)