Health plans are a key component of integrated care programs in many states. The resources in this section describe strategies that states can use when working with health plans to design and implement successful integrated Medicare-Medicaid programs.
Getting Results from D-SNPs: How Medicaid Agencies Are Building Medicare Knowledge for Oversight and Monitoring
Features insights from the conversations with Medicaid official in the District of Columbia, Minnesota, and Washington State, on how their agencies developed the Medicare knowledge necessary to establish monitoring and oversight for integrated D-SNP models.
What Medicaid Officials Need to Know About the Medicare Advantage Star Rating System
Can help Medicaid and partner agency staff understand how Medicare Advantage plans are paid, including some of the unique aspects of Medicare Advantage payment policy applicable to D-SNPs.
What Medicaid Officials Need to Know About Medicare Advantage Supplemental Benefits
Can help Medicaid and partner agency staff learn about the different types of Medicare Advantage supplemental benefits and their relevance to Medicare Advantage enrollees, health plans, and state officials.
What Medicaid Officials Need to Know About Medicare Advantage Payment Policy and Rate Setting
Can help Medicaid and partner agency staff understand how Medicare Advantage plans are paid, including some of the unique aspects of Medicare Advantage payment policy applicable to D-SNPs.
What Medicaid Officials Need to Know About Medicare Advantage Contracting and Bid Development
Can help Medicaid and partner agency staff understand the Medicare Advantage contracting process, including the components of the Medicare Advantage application and the annual contracting timeline.
Providing Value-Added Services for Medicare-Medicaid Enrollees: Considerations for Integrated Health Plans
Explores how health plans are addressing members’ service needs that are beyond the scope of traditionally covered Medicare or Medicaid services, as well as assessing the value of offering these services.
Ensuring Stable Housing for Medicare-Medicaid Enrollees with Long-Term Care Needs
Describes how several states are addressing the housing needs of dually eligible beneficiaries who use long-term services and supports.
Housing Options for High-Need Dually Eligible Individuals: Health Plan of San Mateo Pilot
Describes a pilot program developed by a health plan that was designed to help dually eligible individuals in nursing facilities transition back to community living and support those at risk of nursing home placement to remain in the community.
Building a Culture of Engagement for Medicare-Medicaid Enrollees: Health Plan Approaches
Outlines promising strategies that health plans can use to engage dually eligible individuals with complex medical, behavioral health, and social service needs.
Key Attributes of High-Performing Integrated Health Plans for Medicare-Medicaid Enrollees
Introduces a framework of key attributes necessary for high-performing health plans to support integrated care.
Strategies to Facilitate Managed Care Implementation for Medicare-Medicaid Enrollees
Describes two strategies -- using health plan readiness review and monitoring implementation -- used by Medicaid agencies in four states to facilitate implementation of new managed care programs.
Engaging Providers in Building Managed Care Delivery Systems: Tips for States
Offers tips to help states effectively engage providers in managed care program design and implementation.