Skip All Navigation

Options for Including Medicare

Applicable Authorities

If you wish to include Medicare and hold MLTSS contractors accountable for fully integrated Medicare and Medicaid services, you can consider two federal Medicare authorities to use in combination with Medicaid authorities.

  • The Program for All-inclusive Care for the Elderly (PACE) has authority to include both Medicare and Medicaid services.  It is a very specific site-based model of care serving beneficiaries who are 55 years and older and meet nursing facility level of care.

  • Section 1115A of the Social Security Act was enacted as part of the Affordable Care Act to allow CMS to test innovative approaches to reduce costs and improve quality in the Medicare and Medicaid programs.   As of December 2011, it had not yet been applied to test an innovative Medicare-Medicaid program, although many states were developing proposals for CMS. 

In addition, health plans can qualify directly with the federal government to be Medicare Advantage Special Needs Plans (SNPs). Authority for SNPs has resulted in a special type of Medicare Advantage plan that may limit enrollment to Medicare-Medicaid beneficiaries.  The plans have contracts with CMS for Medicare services and companion contracts with state Medicaid agencies for Medicaid services.

See the Federal Authorities section for more information.

Click on Worksheet 4.4 to help you think about Medicare options. Worksheet 4.4



< Back      Next >