For the past decade, policymakers have sought to improve the integration of Medicare and Medicaid for individuals who are eligible for both programs. While many states are pursuing new opportunities to improve care for dually eligible beneficiaries, some states that are new to integration may not know where to start. This brief outlines key questions for states to consider as they explore options for better coordinating care delivery for this population.

States exploring Medicare-Medicaid integration should begin by considering several factors: (a) the characteristics of the state’s dually eligible populations; (b) the landscape of the state’s health care environment; (c) stakeholder support; (d) the state’s internal capacity and resources; and (e) the degree of integration it seeks to pursue. Developing a strategy based on these factors can support states in selecting a realistic and achievable integration approach while also meeting their policy goals.