State Pathways to Integrated Care: Exploring Options for Medicare-Medicaid Integration

Implementation Tool
April 2019

States have many different options to improve integration, alignment, or coordination of Medicare and Medicaid for individuals who are dually eligible for both programs. It can be difficult for states to know where to start, and how to assess which policy and program activities are best suited for its current environment, market, and delivery system structure.

The Integrated Care Resource Center, a technical assistance center funded by the Centers for Medicare & Medicaid Services' Medicare-Medicaid Coordination Office, created this implementation tool to help guide states to advance integration. Concrete steps outlined in this tool include opportunities to address foundational issues, such as changes in data policies to better understand dually eligible individuals, as well administrative actions such as coordinating Medicare cost-sharing to major program demonstrations or managed care initiatives. Building on these foundational actions, the toolkit also walks through larger delivery system and financing reforms that can expand access to integrated care, including various pathways to integrated care. States can use this tool to develop their own journey toward integration.

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