Advancing Medicare-Medicaid Integration

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Advancing Medicare – Medicaid Integration (AMMI)

Medicare and Medicaid integration has been an ongoing collaborative effort of the Department of Social and Health Services and the Heath Care Authority with the aim to improve access to and participation in integrated care and services in Washington for the dual eligible population (clients on Medicare and Medicaid) through making strategic improvements to the Medicare Advantage integrated Dual Eligible Special Needs Plan (MA DSNP) program. The goal is  sustainable and meaningful transformation in care delivery for the dually eligible population that addresses the whole person through robust care coordination to ensure physical,  behavioral and social health needs are being met. The state leverages available data around Medicare-Medicaid integration and the dual population to improve tracking of quality measures, performance and, reviews dual eligible beneficiary feedback and communications to improve and expand future communications and educational resources to dual beneficiaries, their advocates and community partners to better address health equity among dual eligible clients.

Washington’s goals:

  1. Implement new D-SNP policies and contract requirements in the State Medicaid Agency Contract (SMAC) with Medicare Advantage plans;
  2. Enhance Washington’s capacity for Medicare and Medicaid data analytics;
  3. Educating dual-eligible individuals and their advocates about care coordination and the value of integrated  care options.

What does it mean to be dual eligible?

Dual eligibles are individuals who are entitled to Medicare Part A and/or Part B and are eligible for some form of Medicaid benefit (CMS Dual Eligibles).

What is a Dual Eligible Special Needs Plan (DSNP)?

DSNPs are a subset of Medicare Advantage plans sold by private insurance companies and enroll individuals who are entitled to both Medicare and Medicaid and encompass all categories of Medicaid eligibility including:

  • Full Medicaid Qualified Medicare Beneficiary (QMB only & QMB Plus): helps pay Part A, B premiums (or both), deductible, coinsurance, copays
  • Specified Low- Income Medicare Beneficiary (SLMB only & SLMB Plus): helps pay only Part B premium
  • Qualifying Individual (QI): helps pay Part B premiums only, limited annual funds, can’t be eligible for another Medicaid eligibility group
  • Qualified Disabled and Working Individual (QDWI): Pays only Part A premiums for disabled working beneficiaries

About the AMMI Initiative

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Client Resources

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Frequently Asked Questions