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Optimizing State Medicaid Agency Contracts

The Commission previewed a draft chapter on state Medicaid agency contracts (SMACs) and how states can optimize and oversee these contracts with Medicare Advantage (MA) dual eligible special needs plans (D-SNPs). Over the past year, staff have reviewed SMACs and interviewed stakeholders about the tools and requirements that state Medicaid agencies have for overseeing their contracts with D-SNPs. The chapter describes findings from this work, in addition to highlighting how states face barriers to overseeing their SMACs that reflect broader challenges that prior Commission recommendations on integrated care for dually eligible individuals sought to address.

The chapter concludes with two recommendations, one made to states and one made to 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.