Dual Eligibles

This infographic provides information on coverage and costs for individuals with Medicaid and Medicare. The infographic describes people with both Medicaid and Medicare, complex health care needs of those dually eligible and spending, limited coordinated care between the programs, and ways to improve coordination.

Justice in Aging has published a fact sheet providing guidance for advocates working with older adults who are dually eligible for Medicare and Medicaid. It emphasizes two important features of the Medicare Part D Low-Income Subsidy (LIS): Medicaid termination does not immediately end LIS enrollment, and LIS eligibility is often more generous than Medicaid and Medicare Savings Program (MSP) eligibility rules. The fact sheet offers practice tips to help advocates ensure that older adults understand their LIS enrollment during the Medicaid unwinding period and their options for continuing their LIS coverage...

The Medicaid and CHIP Payment and Access Commission (MACPAC) and the Medicare Payment Advisory Commission (MedPAC) have released an updated data book which presents information on the demographic and other personal characteristics, expenditures, and health care utilization of individuals who are dually eligible for Medicare and Medicaid coverage.

The KFF recently published two analyses on demographics and program enrollment and spending of Medicare and Medicaid dually eligible beneficiaries or dual eligibles. The article, “A Profile of Medicare-Medicaid Enrollees”, analyzes the demographic, socioeconomic, and health characteristics of dual eligibles using data from the 2020 Medicare Current Beneficiary Survey. The second article, “Enrollment and Spending Patterns Among Medicare-Medicaid Enrollees (Dual Eligibles)”, examines national and state-level data on enrollment and spending for Medicare-Medicaid enrollees. The authors used data from the 2019 and 2020 Medicare Beneficiary Summary Files and the 2019 Transformed Medicaid Statistical Information System for this analysis.

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.

MACPAC has released its June 2022 Report to Congress on Medicaid and CHIP. The report recommends measures that Congress can take to better monitor access to care for Medicaid beneficiaries, improve the oversight and transparency of managed care directed payments, increase access to vaccines for adults enrolled in Medicaid, encourage the uptake of health information technology in behavioral health, and better integrate care for Medicaid and Medicare dual-eligibles. The commission also offers policy levers that states and the federal government can use to promote equity in Medicaid.

CMS has released a new proposed rule with several provisions related to dual eligible individuals and would impact states. The proposed rule includes provisions to: Limit retroactive Medicare Part B premium liability for states to 36 months, Retire the old stand-alone buy-in agreements and specify that the provisions of a state buy-in agreement shall be set forth in the state’s Medicaid state plan, Extend the Medicare Savings Programs (MSPs) to cover premiums and cost sharing for individuals enrolling in the new Medicare immunosuppressive drug benefit. CMS is currently requesting comments on the proposed rule.

The Medicaid and CHIP Payment and Access Commission (MACPAC) and the Medicare Payment Advisory Commission (MedPAC) have released an updated data book, Beneficiaries Dually Eligible for Medicare and Medicaid. This is the sixth edition of the book and describes the dually eligible population’s composition, service use, and spending in 2019. The book compares subgroups of dually eligible beneficiaries, such as those with full and partial benefits as well as those under age 65 and those ages 65 and older.

ACL has summarized the CDC's latest COVID-19 vaccination and booster reccomendations on their resources page. The webpage includes a section of resources for the Aging and Disability Networks and guidance for people who are immunocompromised.

As part of its ongoing efforts across many channels to expand Americans’ access to free testing, the Biden-Harris Administration is requiring insurance companies and group health plans to cover the cost of over-the-counter, at-home COVID-19 tests, so people with private health coverage can get them for free starting January 15, 2022.