Project Overview
To provide technical assistance and support to states and the Centers for Medicare & Medicaid Services Medicare-Medicaid Coordination Office (MMCO) regarding options for improving and integrating care for dually eligible individuals.
Despite often facing a variety of chronic conditions and functional needs, dually eligible individuals must navigate two separate, siloed systems of care in Medicare and Medicaid. The Integrated Care Resource Center project was designed to help CMS and states better integrate Medicare and Medicaid benefits to improve care for this population.
- Center for Health Care Strategies
- Infocrossing
- Institute for Exceptional Care
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Medicare - Medicaid Coordination Office
Dually eligible individuals are simultaneously low-income and over the age of 65 or under the age of 65 with disabilities. People who are dually eligible are more likely to have a disability and/or several chronic conditions than people with Medicare alone, more likely to require long-term services and supports (LTSS), and more likely to experience social and environmental risk factors that can impact health outcomes. Despite these challenges, dually eligible individuals must navigate two separate, siloed systems of care in Medicare and Medicaid.
It was very clear [in this presentation] that the presenters are extremely knowledgeable. It is much harder to be succinct with this type of very technical material than it is to go into detail. I thought the presenters did a really excellent job of keeping their narration high-level, while using the slides to serve as a resource for those who prefer to dig deeper at their convenience. I would highly recommend this presentation to my colleagues, and plan to do so.
Evidence & Insights From This Project
Tips for States with Dual Eligible Special Needs Plans Affected by 42 CFR §422.514(h) Federal Regulations
In April 2024, CMS released new rules at 42 CFR §422.514(h) for D-SNPs with affiliated Medicaid managed care organizations (MCOs). This ICRC tip sheet provides (1) an overview of those new requirements, which take effect in 2027 and 2030, and a summary of rule exceptions, (2) illustrative examples and options for D-SNP compliance with each rule provision, and (3) action steps for states in working with D-SNPs to ensure compliance with these new rules.
Learn MoreDually Eligible Individuals: The Basics
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