Contents
Introduction  ...................................................... 1

Rationale for Integration Through Managed Care .......... .
Types of Integration and Federal Authority ............... .
Background on Managed Care for Dual Eligibles .......... .
Selecting Managed Care Plans and Setting Payment Rates
Under Medicaid and Medicare ................. .
Medicare Special Needs Plans and Passive Enrollment ..... .

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Summary of Medicare/Medicaid Integration Projects ..................... 12
Program of All-Inclusive Care for the Elderly (PACE) ................ 12
State Integration Programs ..................................... 14
Arizona Health Care Cost-Containment System (AHCCCS) ....... 14
M assachusetts Senior Care Options ........................... 15
Minnesota Senior Health Options (MSHO)
and Disability Health Options (MnDHO) .................. 15
New York Medicaid Advantage Program ...................... 16
Texas Star+Plus  ......................................... 16
Washington Medicare/Medicaid Integration Program ............. 17
W isconsin Partnership Program  .............................. 17
Other Activities  ............................................  17
Results of Integration Projects  ...................................... 18
Challenges in Developing Medicare/Medicaid Integration Projects .......... 19
Level of State Investment and Expected Returns on Investment ......... 19

Conflicting Medicare and Medicaid Requirements ... .
Managed Care Payment Rates  ................... .
Federal W aiver Approval ....................... .
Willingness of Medicare Advantage Plan to Contract
with the State Medicaid Agency ............. .
Ability of Medicaid Long-Term Care Providers
to Meet Managed Care Requirements, and
Cover Acute and Primary Services ........... .
Provider Issues ................................
Upper Payment Limit Policies and Managed Care
Other Provider Concerns  ................... .
Attractiveness of Managed Care to Beneficiaries .... .
Policy Considerations for Congress ................... .
L egislation  ..................................  .

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