Dual Eligibles

This technical assistance tool outlines how states can identify aligned and unaligned enrollees within their dually eligible populations. The first option described in this guide is accessing matching CMS data on Medicare enrollment with state data on Medicaid enrollment. The second option reviewed is collecting aligned enrollment data ddirectly from D-SNPs. This guide includes additional resources states can use to collect more information on identifying Medicare plan enrollment for duals.

This webinar discussed two issue briefs from the MLTSS Institute on aligning Medicare and Medicaid for dually eligible individuals. The briefs covered were, "Starting from Square One: Considerations for States Exploring Medicare-Medicaid" and, “The Value of Integration to State Medicaid Agencies”. The webinar also highlighted the perspective of the District of Columbia, which is planning to launch new program elements to better integrate care.

This case study explores how health plans can help rebalance LTSS for dually eligible members. It looks at two California health plans who successfully transitioned dually eligible members from institutional to community settings. The case study uses these two examples to identify key elements for supporting dually eligible individuals with LTSS needs during the transition to living in the community.

This report is the fourth in a series of publications from the MLTSS Institute, which was established in 2016 to drive improvements in key MLTSS policy areas, facilitate sharing and learning among states, and provide direct and intensive technical assistance to states and health plans. This issue brief focuses on delivering effective care to individuals eligible for both Medicare and Medicaid and aims to lay out the case for state Medicaid agencies to invest in integrated care programs.

This technical assistance tool focuses on the new “information sharing” requirement for Dual Eligible Special Needs Plans beginning in 2021. The tool explains the new requirement as well as how to address the requirement in mandatory D-SNP contracts.

This infographic provides information on coverage and costs for low-income Medicare beneficiaries. The resource describes people on Medicare, financial needs among beneficiaries, programs supporting low-income beneficiaries, and ways to improve access.

To understand both the needs of people who use long-term services and supports (LTSS) through Medicare and Medicaid coverage and ways to apply quality measurement to this population, the National Committee for Quality Assurance (NCQA), supported by The SCAN Foundation, developed a roadmap for evaluating the quality of integrated care for dual eligibles.

The CMS Medicare-Medicaid Coordination Office (MMCO) regularly reports data on Medicare-Medicaid enrollee demographics, service utilization, spending, and other characteristics that can give states a more comprehensive view of this population. This tool shows states how to use these data to create tables, graphs, and figures and interpret their meaning for a wider audience of stakeholders.

For individuals who receive services from both Medicare and Medicaid, care is often fragmented across a wide array of medical, behavioral health, and long-term care providers. Medicare and Medicaid offer otherwise uncoordinated systems of care with different eligibility criteria, benefits, provider networks, and enrollment processes. This issue brief describes key features of effective integrated care programs and presents top policy considerations driving state investment in these programs.

This brief from the Integrated Care Resource Center discusses opportunities for Medicaid agencies to partner with State Health Insurance Programs (SHIPs). Every state has a SHIP that is responsible for providing counseling and assistance for people with Medicare and their families. This brief highlights approaches used by Arizona, Massachusetts, and Texas, where SHIPs and Medicaid agencies have worked together to educate Medicare-Medicaid enrollees on new care delivery options.