Dual Eligibles

Innovative Approaches to Stratification and Rate Setting

Stratifying Medicare-Medicaid enrollees by their level of need may help states and health plans prioritize and promptly address the care management needs of these individuals in order to ensure high-quality, timely care. This new brief from the Center for Health Care Strategies describes how three states - California, Ohio, and Virginia - are accomplishing this work.

Dual Eligible Special Needs Plans (D-SNPs): Recommendations for Medicare and Medicaid Integration

In an effort to improve care for dual eligibles and align financing between Medicare and Medicaid some states are pursuing dual eligible special needs plans (D-SNPs) as an option to integrate care.  The National Association of Medicaid Directors paper, "Advancing Medicare and Medicaid Integration:  Improving the D-SNP Model for Dually Eligible Beneficiaries," identifies challenges in D-SNP integration and recommendations for remo

Comparison of Eight Dual Eligible Integrated Care Demonstrations

The Affordable Care Act created an opportunity for states to test new service delivery systems and financing approaches for those dually eligible for Medicare and Medicaid.  At the time of this brief, eight states had signed memorandums of understanding with the Center for Medicare and Medicaid Services defining details of the demonstrations.  The Kaiser Commission on Medicaid and the Uninsured  brief, "Financial and Administrative Alignment Demonstrations for Dual Eligible Beneficiaries Compared:  States with Memoranda of Understanding Approved by CMS," provides a comparison of the dual eligible integrated care demonstrations.

Dual Demonstration Project: A Look at Beneficiary Protections

The duals coordinated care demonstration projects require a three-way contract between participating states, health plans, and the Center for Medicare and Medicaid Services (CMS).  Massachusetts was the first state to sign a three-way contract.  The National Senior Citizen’s Law Center report,  "Massachusetts Three-Way Contract:  A Summary of Beneficiary Protections," provides insight into the rights

Consumer Choice and Continuity of Care in Managed LTSS

As more states transition Medicaid long-term services and supports (LTSS) to a managed care model, growing attention is being placed on consumer protections.  AARP published a report, "Consumer Choices and Continuity of Care in Managed Long-Term Services and Supports:  Emerging Practices and Lessons," identifying strong consumer education strategies as paramount to increased consumer involvement and meaningful choice.  While consumers did not experience significant interruptions in services during the transition period to managed LTSS, continued monitoring will be required for long-range impact on choice and continuity of care as plans gain more flexibility in managing their networks.

Medicare Spending and Beneficiary Demographic Data

The MedPAC Data Book provides information on national health care and Medicare using tables and figures with brief discussions.  Information covered includes Medicare spending, Medicare beneficiary demographics, dual-eligible beneficiaries, quality of care in the Medicare program, and examination of provider settings.

Who Are the Dual Eligibles?

With impending changes to the health care delivery system for people dually eligible for Medicaid and Medicare, it is helpful to understand beneficiary experiences.  The Kaiser Family Foundation report, "Faces of Dually Eligible Beneficiaries:  Profiles of People with Medicare and Medicaid Coverage," brings the human side to the conversation.

Comparison of MOUs for Dual Eligible Financial Alignment Demonstrations

States have an opportunity to improve service delivery and share in cost savings with Medicare through the integrated care and financial alignment demonstrations for dual eligibles.  CMS has finalized memoranda of understanding (MOU) with five states, including California.  The Kaiser Commission on Medicaid and the Uninsured issue brief, "Financial Alignment Demonstrations for Dual Eligible Beneficiaries Compared: States with Memoranda of Understanding Approved by CMS," provides an overview of provisions in the five demonstrations.  Review of the MOUs provides insight into future systems changes and issues still needing to be addressed.

Transitioning Beneficiaries with Complex Care Needs to Medicaid Managed Care: Insights from California

States looking to better coordinate care and manage cost are seriously considering the managed care model as an option to provide Medicaid services to people with complex health care needs.  The Kaiser Commission on Medicaid and the Uninsured issue brief, "Transitioning Beneficiaries with Complex Care Needs to Medicaid Managed Care:  Insights from California,"  examines how providers, health plans, and community-based organizations in three counties (Contra Costa, Kern, and Los Angeles) experienced the California’s transition of approximately 240,000 seniors and people with disabilities to Medicaid managed care.  This brief reinforces the need for adequate time, communication, planning, and partnerships in order to ensure continuity of care.

Dual-Eligible Beneficiaries of Medicare and Medicaid: Characteristics, Health Care Spending, and Evolving Policies

Attention has been given to dual eligibles (people who use both Medicaid and Medicare) due to the rising cost of care and fragmented service system.  In the report, "Dual-Eligible Beneficiaries of Medicare and Medicaid:  Characteristics, Health Care Spending, and Evolving Policies," CBO takes a closer look at data describing duals, spending trends, and efforts to better coordinate services and reduce cost.

Pages