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Optimizing State Medicaid Agency Contracts

Chapter 2 explores steps toward better coordination of care for people who are dually eligible for Medicaid and Medicare and makes recommendations for how states can optimize and oversee state Medicaid agency contracts (SMACs) with Medicare Advantage dual eligible special needs plans (D-SNPs). Dually eligible beneficiaries who are eligible for both Medicaid and Medicare may experience fragmented care and poor health outcomes when their benefits are not coordinated.

The chapter highlights the role of care coordination data in assisting state efforts to evaluate integrated care and to oversee and monitor D-SNPs. Building on prior work, the Commission makes recommendations to states and the Centers for Medicare & Medicaid Services, that are intended to support states by providing a starting point for optimizing and overseeing SMACs and to explain how integrated care may benefit beneficiaries residing in their states.

From: June 2024 Report to Congress on Medicaid and CHIP