Dual Eligibles

Most Medicaid beneficiaries are enrolled in some form of managed care. States are expected to increase their reliance on managed care to deliver services in their Medicaid programs. This 50-state survey provides a comprehensive look at state Medicaid managed care programs, documenting their diversity, examining how states monitor access and quality, and exploring emerging efforts to improve care, including managed long-term care and initiatives targeted toward dual eligibles.

To improve beneficiary care and reduce unnecessary expenditures, a number of states have developed programs and initiatives aimed at improving the coordination and management of care for dual eligibles—beneficiaries enrolled in both Medicaid and Medicare for their health care services. This report reviews the experiences in nine states to determine the lessons that can be learned from experience.

This issue brief is the first in a series of four papers designed to highlight pressing issues facing dual eligibles and provide recommendations to the Medicare-Medicaid Coordination Office, state Medicaid agencies and other interested policymakers and stakeholders on how to address them. This first paper provides recommendations for consumer protections in delivery system models that integrate Medicare and Medicaid.

Are you looking for state data on people who are simultaneously enrolled in Medicare and Medicaid? Find a number of useful interactive tables, charts, and graphs including Medicaid spending by service, spending per dual eligible, dual eligible enrollment, duals as a percentage of Medicaid enrollees, and more.

Five innovative states (Arizona, Hawaii, Tennessee, Texas, and Wisconsin) with demonstrated expertise in managed care approaches for individuals with long-term care needs are featured in this report. The resulting “roadmap” outlines 10 critical mileposts for successfully designing models for managed LTSS. It also identifies key ACA provisions that support state efforts to improve long-term care delivery.

Millions of low-income adults without children who currently cannot qualify for coverage, as well as many low-income parents and children now covered through the CHIP program will become eligible for Medicaid. These programs are expected to cover an additional 16 million people by 2019. This brief provides the details of the benefit and cost-sharing rules that will govern the coverage available to newly-eligible adult Medicaid beneficiaries.

Fourth and final in a series that explores the cross-payer effects of providing Medicaid long-term supports and services on Medicare acute care resource use, this report provides a summary of the initial work of a study, described more fully in the first three reports, with an emphasis on lessons that state Medicaid administrators should consider as they move toward more formal programs of integrated care for persons dually eligible for Medicare and Medicaid.

As states assess the challenges and opportunities presented by federal health reform legislation, there is a natural tendency to focus on the most immediate issues, but it is equally important that states begin planning for the many aspects of implementation that occur in later years. This State Health Policy Briefing identifies and describes ten aspects of federal health reform that states must get right if they are to be successful in implementation.

How do dually eligible beneficiaries affect state MIG grant programs? Rhode Island and the University of RI, College of Pharmacy produced a chart book which highlights demographics, healthcare services, expenditures and the variation in cost by settings of care for seniors and people with disabilities who were enrolled in both Medicare and Medicaid between 1995-2005. Objectives and findings are included. An sample of this book is attached and could be helpful to other MIG grantees.

The Sherlock Plan is the name of Rhode Island’s MIG program. It allows qualified working people with disabilities to earn more income without the risk of losing vital health care coverage. To inform consumers about the program, they have provided a plan overview, fact sheets in Spanish and English, and more information on their "Rhodes to Independence" website. Samples of these documents and a link to the site are available.