Integrated Care Overview

Glossary of Terms Related to Integrated Care for Dually Eligible Individuals

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.

State Pathways to Integrated Care

To help states explore their options for Medicare-Medicaid integration, ICRC created this tool, which shares steps states can take to advance integration, beginning with relatively simple administrative actions and moving to more advanced activities involving delivery system changes.

Alignment of Medicare Savings Program Eligibility with the Medicare Part D Low Income Subsidy Program

The Medicare Savings Programs (MSPs) are Medicaid programs (or categories of Medicaid eligibility) that provide payment for Medicare premiums and/or cost sharing for low-income individuals. This tip sheet details one way a state can improve the MSP eligibility determination process by aligning its MSP eligibility criteria with those used for the Medicare Part D Low-Income Subsidy (LIS) program to facilitate the use of LIS eligibility data in determining eligibility for MSPs.

People Dually Eligible for Medicare and Medicaid

In 2017, there were 12 million individuals dually eligible for Medicare and Medicaid. This fact sheet provides information on their reasons for Medicare eligibility, costs of care, and enrollment in managed care as well as the proportion of these beneficiaries who receive their care through arrangements that integrate their Medicare and Medicaid benefits.