duals

On July 19, 2022 MedPAC released its July 2022 Data Book on Health Care Spending and the Medicare Program. This publication provides data on Medicare spending, demographics of the Medicare population, beneficiaries’ access to care, and Medicare program quality. Section 4 (pages 31-38) covers dually eligible individuals and includes information on the percentage of Medicare spending for this population, demographic data, health status, and service use. Within this section, states may be specifically interested in Chart 4-4: Demographic differences between dual-eligible beneficiaries and non-dual-eligible beneficiaries, 2019.

A 2020 study, developed and led by people with disabilities, examined member engagement and outcomes in the Massachusetts One Care Program, which provides comprehensive, integrated, coordinated care for dually eligible individuals under 65. The Better Care Playbook spoke with Dennis Heaphy, MPH, MEd, MDiv, a policy analyst and health justice advocate at the Massachusetts Disability Policy Consortium and a One Care member, to learn more about the findings of the One Care study. This blog post highlights the impact of engaging members with disabilities in care planning and strategies that health systems and payers can use to advance health equity through improved engagement with people with disabilities.

This guide highlights the benefits and opportunities available for CBOs interested in providing services under Medicare FFS. It describes important considerations including billing and filing processes, culture change, and regulatory compliance. The guide also reviews how to enroll as a Medicare provider and outlines which services CBOs can offer.

This technical assistance tool explains how states can identify Medicaid enrollees who are dually eligible and those who are prospective dual eligibles. The guide outlines how states exchange files with CMS through the Medicare Modernization Act (MMA) file exchange process to identify these individuals. This resource describes how the monthly MMA file exchange process can benefit both states and dually eligible individuals.

The MACPAC June 2020 Report to Congress on Medicaid and CHIP was created prior to the COVID-19 pandemic and highlights long-term challenges facing Medicaid. Across six chapters, it discusses key issues including integrated care for dually eligible Medicaid and Medicare beneficiaries, Medicare Savings Programs, and Medicaid's statutory role as the payer of last resort.

The Financial Alignment Initiative (FAI) is intended to improve the quality of care and reduce spending for low-income people who are dually eligible. Mathematica researchers conducted a study to identify reasons for the varying participation rates across states. This brief explores the details of two major factors: passive enrollment and demonstration/MLTSS alignment.

In 2021, under a recently released rule from CMS, D-SNPs will be required to notify the state or state’s designee when enrollees experience Medicare-covered hospital or skilled nursing facility admissions in order to ensure timely transitions of care. The Integrated Care Resource Center has released a brief that examines approaches from three states – Oregon, Pennsylvania, and Tennessee – to develop and implement information-sharing processes for their D-SNPs that support care transitions.

This report summarizes the Medicare Parts A & B actuarial savings analysis of the Washington managed fee-for-service (MFFS) demonstration for 2015 and 2016. The Washington Health Home MFFS demonstration aims to improve service quality and integration while reducing costs of care for high-risk, high-cost dually eligible beneficiaries. For 2015, Washington demonstrated a final gross Medicare savings of $30 million. The preliminary gross Medicare savings for 2016 are $42 million.