Individuals enrolled in both Medicare and Medicaid, referred to as dually eligible beneficiaries, may be eligible for Medicaid assistance with their Medicare premiums and Part A and B cost sharing (i.e. deductibles, coinsurance, and copayments). Under Section 1902(n) of the Social Security Act, states are not required to pay the full Medicare cost sharing amount if the total provider payment from Medicare and Medicaid would exceed the state’s Medicaid rate. This gives states flexibility in establishing payment policies for their Medicaid payment of Medicare Part A and B cost sharing, often referred to as Medicare crossover policies. Most states have either ‘full payment’ or ‘lesser of’ Medicare crossover policies; however, a few states have other policies. These policies can also differ within a state across service types. For more information about Medicare crossover policies, see this policy in brief: https://www.macpac.gov/publication/state-medicaid-payment-policies-for-medicare-cost-sharing-2/.
This compendium provides state-level information on Medicare crossover policies for inpatient hospital services, outpatient hospital services, nursing facility services, and physician services. The tab labeled “summary” presents an overview of the Medicare crossover policies in each state across service types. The tabs labeled with each service type provide more detailed information about Medicare crossover policies in each state for that service type.