State Medicaid agencies have made considerable progress in implementing integrated Medicare-Medicaid programs to address the diverse needs of dually eligible individuals and better coordinate their care. Leading states are thoughtfully assessing what is and is not working, and making refinements based on their findings.

This brief highlights insights from states that fine-tuned their integrated care programs following initial development and implementation, which can help other states design their own integrated care programs to better meet beneficiary needs. Key priorities for refining integrated approaches include: (1) modifying care management models and requirements; (2) improving beneficiary understanding of coordinated care; (3) developing strategies to increase enrollment; (4) enhancing administrative alignment between Medicare and Medicaid program rules; and (5) supporting health plan sustainability.