Implementing "Medicare-First" Exclusively Aligned Enrollment: Key Steps & Considerations for States

During this webinar, ICRC staff provide an overview of the Medicare enrollment process used by dual eligible special needs plans (D-SNPs) and describe key steps and considerations for states that choose to align Medicaid coverage with D-SNP enrollment. We expect this webinar to be of interest to states with integrated D-SNPs that must achieve exclusively aligned enrollment by 2030, per the rules at 42 CFR 422.514(h)(2), as well as states that are otherwise interested in requiring D-SNPs to operate with exclusively aligned enrollment in the future.

Learning Objectives: By the end of this presentation, attendees should be able to:

• Describe the benefits of exclusively aligned enrollment (EAE) for dually eligible individuals and states;
• Explain why a state may opt to use a “Medicare-first” EAE approach vs. a “Medicaid-first” EAE approach;
• Understand how dually eligible individuals can enroll in a D-SNP and how D-SNPs verify Medicaid eligibility before processing enrollment requests;
• Identify the typical steps that Medicare-first EAE states take to align Medicaid managed care enrollment with D-SNP enrollment; and
• Describe key policy decisions and file exchange options that states should consider before implementing Medicare-first EAE. 

Speakers

• Gretchen Bell, Integrated Care Resource Center
• Elizabeth Boystak, Integrated Care Resource Center
• Katerín Fernández, Integrated Care Resource Center
• Lida Momeni, Integrated Care Resource Center