Integrated Programs for Dual Eligibles is a program that will offer a coordinated benefit package-including care coordination and care management- that is evidence based, promotes value, and contributes to the overall improved health for persons who are jointly eligible for both Medicaid and Medicare. Individuals who are entitled to Medicare coverage and are eligible for some form of Medicaid benefit are usually referred to as a dual eligible.
Our review of 35 states indicates that there is more activity now than ever before in the MMIS procurement and implementation space. MMIS solutions have evolved steadily since they were first mandated and funded in the 1970s. During the past four decades, Medicaid data, system processes and architecture, and transaction specifications have been standardized to allow for improved program management and broader health care IT interoperability. The State's current MMIS is over 20 years old, with components that are over 30 years old. The current MMIS needs to be replaced.
This reference guide covers program categories, rules and State Plan Options that affect Medicaid Eligibility for individuals who are requesting Long-Term Care services or applying for them under the LTC category. The LTC category is also referred to as the 300% Institutionalized Special Income Group. These procedures coincide with the rules pertaining to these categories which can be found at 10 CCR 2505-10 Volume 8 under 8.100.7.
