Dual Eligibles

Posted April 22, 2014
LTSS includes home and community based services (HCBS) as well as care delivered as a part of an extended stay in a nursing facility (NF). This research examined the patterns of health care related events and expenditures that preceded and followed the initiation of LTSS as well as the pattern of LTSS use following a hospitalization. This research identified 474,706 adult (ages 18 years and older) fee-for-service MME beneficiaries in California who initiated at least one type of LTSS during the two-year period of January 2006 to December 2007.
Posted April 17, 2014
Enacted as part of the 2012-2013 California Budget, the Coordinated Care Initiative (CCI) began operation on April 1, 2014. The CCI establishes changes in the way the medical care and long-term services and supports (LTSS) systems work together to serve low-income older adults and people with disabilities. The main components of the CCI include:
Posted April 15, 2014
State Medicaid programs are moving from fee-for-service to managed care delivery systems for individuals with complex care needs, particularly those who are dually eligible for Medicare and Medicaid or who use long-term services and supports. To provide better integrated and more cost effective care, states are developing managed long-term service and supports programs or capitated financial alignment demonstrations for dually eligible individuals.
Posted February 24, 2014
Behavioral health disorders—which include mental illness and/or substance use disorders—are among the most prevalent and disabling conditions affecting individuals who are eligible for Medicare and Medicaid (also known as “dual eligibles” or Medicare-Medicaid beneficiaries). One in four Medicare-Medicaid beneficiaries aged 65 and older and nearly 40 percent under age 65 have a mental health disorder.
Posted January 22, 2014
Medicaid is the single largest payer for long-term services and supports for low-income seniors and certain individuals with disabilities in the United States. It constitutes the only safety net coverage of comprehensive LTSS in the nation. Medicaid is jointly financed by federal and state governments. Within broad federal guidelines, each state designs and administers its own Medicaid program. California’s Medicaid program, Medi-Cal, is administered by the California Department of Health Care Services.
Posted January 14, 2014
More than 450,000 “dual eligible” adults (those insured through both Medicare and Medi-Cal) in eight California counties are slated to be moved from fee for service to managed care starting in April 2014. New data from the UCLA Center for Health Policy Research’s HOME project find that those who will be affected by the transition are often confused or concerned about its potential effects on their health care.
Posted September 19, 2013
Home- and community-based services (HCBS) are a significant and growing area of service delivery in Medicaid programs, and California is pursuing long-term services and supports (LTSS) policies to deliver high quality care while managing costs. The report considers the demographics, health status, HCBS use, and care costs of adult Medi-Cal beneficiaries (18 and older) prior to an extended stay nursing facility admission between 2006 and 2008. 
Posted September 18, 2013
Medicaid is the single largest payer of nursing facility (NF) care (also referred to as nursing home care) in the United States, accounting for 31% ($46.1 billion) of the total $149.3 billion spent nationally on this care in 2011. Medi-Cal alone, California‟s Medicaid program, spent nearly $3 billion on NF care in 2008 for eligible beneficiaries in fee-for-service (FFS) who were age 18 and above.
Posted July 19, 2013
State Medicaid programs are transforming their long-term services and supports (LTSS) delivery systems from fee-for-service to managed care to better integrate LTSS with primary, acute, and behavioral health care. By 2014, 26 states are projected to have Medicaid managed long-term services and supports programs. Given strong state management and oversight, these programs enable states to provide high-quality, person-centered, and cost-effective care to eligible beneficiaries in the setting of their choice.