Tip Sheet

Tips to Improve Medicare-Medicaid Integration Using D-SNPs: Integrating Medicaid Managed Long-Term Services and Supports into D-SNP Models of Care

Dual Eligible Special Needs Plans (D-SNPs) must develop a model of care (MOC) that describes their enrollees’ characteristics and health and service needs as well as the plan’s care coordination and health risk assessment processes. Despite the importance of Medicaid services to dually eligible enrollees, D-SNPs are only required to describe Medicare services in their MOCs. However, states may require D-SNPs to develop an integrated MOC that describes not just how Medicare services will be provided, but also how the plan will provide and/or coordinate Medicaid benefits.

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.

Tips to Improve Medicare-Medicaid Integration Using D-SNPs: Using Medicare Program Audit Reports to Improve Managed Care Organization Oversight

This tip sheet describes how states can use the results of Medicare program audits to identify performance issues impacting dually eligible beneficiaries’ receipt of care coordination, long-term services and supports, durable medical equipment, and other services, and incorporate that information into their audit and oversight activities.

Tips to Improve Medicare-Medicaid Integration Using D-SNPs: Designing an Integrated Summary of Benefits Document

This tip sheet describes how states can start to improve member materials by using contractual requirements to ensure that Medicare and Medicaid benefit information for aligned plans is incorporated into a single, streamlined Summary of Benefits (SB) document.

Tips to Improve Medicare-Medicaid Integration Using D-SNPs: Promoting Aligned Enrollment

This tip sheet outlines tips for promoting aligned enrollment in states looking to integrate care for dually eligible beneficiaries using contracting strategies that maximize the opportunity for Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) and Medicaid managed care (MMC) plans. With aligned enrollment, the beneficiary is enrolled in a D-SNP and MMC offered by the same parent company in the same geographic area (aligned plans).

Tips for States to Advance Person-Centered Planning in Self-Direction Models

This tip sheet offers suggestions for states operating managed long-term services and supports programs or other managed integrated care programs to: (1) understand the person-centered planning process; (2) establish robust contract requirements and policy guidance that support person-centered self-direction models; and (3) assess managed care plans’ person-centered planning practices in self-directed models.

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