Dual Eligibles

Posted December 14, 2012
This presentation explores how managed care is organized and functions, and includes considerations for LTSS providers and stakeholders working in this space.
Posted December 7, 2012
Home- and community-based services (HCBS) are a significant and growing area of service delivery in Medicaid programs, and California is interested in pursuing policies that can support high quality care and contain costs. A major barrier to planning, monitoring and evaluating HCBS programs has been the complexity of the available information that is often spread across multiple data systems.
Posted December 5, 2012
In an attempt to slow down growth in health care spending, state and federal governments have implemented a number of cost-containment strategies in recent years. Medicaid and Medicare expenditures are major contributors to the long term fiscal challenges facing the public sector. Medicaid, financed by both federal and state governments, pays for acute, post-acute, and long term services and supports (LTSS) for low-income seniors and certain individuals with disabilities, among others.
Posted September 10, 2012
Senate Bill 208 (Steinberg, Chapter 714, Statutes of 2010) authorized a pilot project that would integrate the full range of Medicare and Medi-Cal (California’s Medicaid program) services, including Medi-Cal long-term services and supports (LTSS) and behavioral health services for individuals eligible for both programs (“dual eligibles” or “Medicare-Medicaid enrollees”).
Posted July 16, 2012
Medicare beneficiaries can also qualify for Medicaid through the medically needy coverage option. States may choose to provide Medicaid to individuals with higher incomes but who, due to their high medical expenses, have met state “spend-down” requirements. This means that after deducting medical expenses from their monthly income, they are below poverty. Most states also allow individuals who require nursing home care to qualify for Medicaid at 300% of SSI ($2,022 per month in 2011 for individuals).
Posted July 16, 2012
Individuals who do not qualify for full Medicaid but still need financial assistance with Medicare premiums and cost-sharing are often referred to as “partial” or “supplemental” duals. These individuals can participate in one of the four Medicare Savings Programs (MSPs) under which Medicaid supplements Medicare on behalf of the beneficiary.
Posted July 16, 2012
Dual eligibles are more likely to have a mental illness, require help with 3 or more Activities of Daily Living (ADLs), and live in an institution than Medicare-only beneficiaries. 24% of dual eligibles need help with 3 or more ADLs as compared to 6% of Medicare-only beneficiaries. 33% of duals have a mental illness versus 15% of Medicare-only beneficiaries. 17% of duals live in an institution versus 2% of their Medicare-only counterparts.
Posted July 12, 2012
Dual eligibles are more likely to have more chronic conditions, have a mental illness, and have functional impairments than Medicare-only beneficiaries. When compared to Medicare beneficiaries with the same number of chronic conditions, dual eligibles spent $54,199 Medicare dollars compared to Medicare-only beneficiaries who spent $38,675 Medicare dollars per capita in 2008.
Posted July 12, 2012
Dual eligibles are more likely to have more chronic conditions, have a mental illness, and have functional impairments than Medicare-only beneficiaries. 79 percent of Medicare spending is on beneficiaries with five or more chronic conditions.
Posted July 12, 2012
This analysis uses 2008 Medicare claims data to identify individuals with four specific diseases: Diabetes, Chronic Obstructive Pulmonary Disease, Dementia and related diseases, and Stroke/Transient Ischemic Attack.