Executives of State Chapters of The Arc in states that are designing integrated healthcare plans for people eligible for both Medicare and Medicaid (Duals) met with officials from the Centers for Medicare and Medicaid Services (CMS), the Administration on Developmental Disabilities (ADD), and The Office on Disability. CMS is working with several states as they redesign their systems of healthcare for Duals in an effort to improve care and reduce costs. Approximately, one-third of Duals are individuals with disabilities. The state chapter executives shared their vast experience in designing services and supports for individuals with I/DD with federal officials. Numerous suggestions were offered concerning essential, non-negotiable elements that must be made part of any healthcare design that integrates medical care and long term services and supports for individuals with I/DD.