Integrating Medicare and Medicaid Services Through Managed Care Page: 3 of 33
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Contents
Introduction ...................................................... 1Rationale 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 ..... .. . . . . . . . . . . . . .4
. . . . . . . . . . . . . . 6
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. . . . . . . . . . . . . 1 1Summary 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 ......... 19Conflicting 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 .................................. ............................20
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Integrating Medicare and Medicaid Services Through Managed Care, report, January 18, 2007; Washington D.C.. (digital.library.unt.edu/ark:/67531/metadc819861/m1/3/: accessed February 21, 2019), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT Libraries Government Documents Department.