• Introduction and Learning Objectives
• MLTSS Basics
• Universal Features
• Program Design Choices

• Target Populations
• Enrollment
• Service Coordination
• Options for Including Medicare
• Covered Services
• Provider Networks
• Consumer-Directed Services
• Financial Incentives

• Federal Authorities
• Organizational Capacity & Competencies
• Case Studies

Options for Including Medicare

Sample Contract Language

The following excerpts include examples from four states – Arizona, Massachusetts, Minnesota, and Wisconsin – that have fully integrated Medicare-Medicaid MLTSS programs and shows how each differs in the way it addresses integration of program services.

1. The first example from Arizona shows a minimalist approach to the contracting language and outlines the state’s expectation for a streamlined option to dually eligible members.
   
   
2. The example from Massachusetts shows how, in an integrated model, the contractor is explicitly responsible for providing both Medicare- and Medicaid-covered services.
   
   
3. The excerpt from Minnesota discusses how the contractor is expected to work with the state and CMS to integrate Medicare and Medicaid.
   
   
4. And, finally, the example from Wisconsin’s contract stipulates the circumstances under which a member could be enrolled in the Partnership program under both Medicare and Medicaid.

 

 

 

 

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