Examples of Potential Projects and Activities

Advancing Medicare & Medicaid Integration seeks to support states in their work to achieve meaningful improvements in Medicare and Medicaid integration — measured by the degree of integration achieved and/or the share of the dual-eligible population impacted.

When developing their project concept, applicants should identify a key objective relating to integrating Medicare and Medicaid services for their dual-eligible population. Once an objective is identified, states should outline one or more activities that initiative funding would support in their efforts to achieve their intended objective.  

Potential project activities could include:

• Capacity assessment. State staffing capacity, skills, and knowledge are key to successfully launching any program serving dual-eligible individuals. Initiative support could be used to hire new staff or engage consultants, build expertise in Medicare and integrated care, or develop knowledge of community-based organizations or others serving dual-eligible populations.
• Model implementation. States seeking to implement larger-scale shifts in care delivery might use this initiative to aid in the creation of Medicaid managed long-term services and supports programs that align with Dual Eligible Special Needs Plans (D-SNPs), develop direct capitation contracts where D-SNPs cover Medicaid benefits, or design new demonstration programs under CMS’ Financial Alignment Initiative or new state-specific demonstration models.
• Evaluation and improvement. In states currently operating integrated Medicare-Medicaid programs, initiative support could be used to evaluate model effectiveness using quantitative and qualitative measures or refine program policies or operations based on evaluation findings.
• Outreach and education. Stakeholder engagement is a crucial component of integrated care programs. Initiative support could be used to conduct surveys or focus groups, hold listening sessions or townhalls, or develop other communication tools. Support could also be used to conduct outreach and education for beneficiaries and providers around the value of integration using websites, marketing materials, or community events.
• Data analytics. Improvements in data analytic capabilities can benefit new or established integrated care programs. Initiative support could be used to build information technology infrastructure, contract with consulting services, expand staffing, or connect health plans or providers to health information exchanges. Support also can be used for quantitative analyses of Medicare and Medicaid data to better understand characteristics of dual-eligible populations or their patterns for service use or costs of care.

Projects may be operated in capitated or fee-for-service Medicaid delivery systems and include all of a state’s dual-eligible population or a subset (e.g., individuals aged 65 and over, individuals with intellectual/developmental disabilities, individuals using long-term services and supports, full-benefit dual-eligible individuals, etc.). While states should aim to integrate the full range of services an individual requires (e.g., primary and acute care, behavioral health care, long-term services and supports), some of these services may be carved out of Medicaid managed care contracts or provided through county-based systems or other waivers. Proposed projects do not need to integrate all these services.

The scale of a state’s proposed project may vary depending on factors including previous efforts to integrate Medicare and Medicaid, experience with Medicaid managed care, state staffing and data analytic capabilities, and degree of stakeholder buy-in. States may propose projects that make a single large-scale shift in care delivery or several smaller-scale changes that represent a significant advancement in the degree of integration achieved or in the size of integrated care enrollment.