Dual Eligibles

The fragmentation of care for dually eligible beneficiaries is an ongoing concern. This brief discusses potential methods of reducing this fragmentation and improving nursing facility care for this population. Recommendations involve concentrating responsibility and accountability for prescription drug use, providing financial incentives for nursing facilities to reduce avoidable hospitalizations, and shifting responsibility for long-term nursing facility care from Medicaid to Medicare.

Does providing Medicaid long-term supports and services influence dually eligible Medicaid recipients’ use of Medicare? Third in a series, this report is intended to provide background information on the interplay of Medicare and Medicaid resources using data from one state (Maryland) as an example for analysts who are examining similar issues at state and federal levels.

Review the key findings of this report which uses information from multiple state and federal data sources and provides the most comprehensive information to date on patterns of Medicaid and Medicare spending and service use among Buy-In participants. Overall findings suggest that Buy-In participants who are working may require fewer services or a less expensive mix of services than other adult disabled Medicaid enrollees.

This brief reviews the history and current status of federal special needs plans (SNPs) authority, with particular attention to provisions of interest to state Medicaid programs that have or are considering entering into contracts with SNPs to integrate or coordinate Medicaid long-term care services with Medicare primary, acute and prescription drug services for dually eligible beneficiaries. Key future changes to the program and a legislative history are outlined.

This series of chart books summarizes demographic, service utilization, and expenditure data for state fiscal years 2001 through 2008 on three Maryland Medicaid waiver programs — Older Adults, Living at Home, and Autism, and on nursing facility utilization among Maryland Medicaid recipients. These books are now available to the public online to monitor trends in these programs.

The CMS website has been updated with the new 508 compliant MSIS Medicaid eligibility and claims tables for federal fiscal years 2005 through 2008 for 31 states. Individual or groups of tables may be selected using the identified dynamic list options. The standard MSIS fiscal year tables will be updated periodically as additional states submit their data for the full fiscal year.

The second in a series, this report explores the cross-payer effects of providing Medicaid long-term supports and services on Medicare acute care resource use. Patterns of Medicaid eligibility, as well as resource use under both Medicare and Medicaid, are examined primarily within the context of service use-based groups that can be used to set rates for Medicaid capitation payments for managed long-term care.

This policy brief presents four options that merit serious consideration in the current health care reform discussions. The first two options would improve long-term care for people with low incomes and limited financial resources. Review ideas on expanding Medicaid support for home and community-based services and improve coordination of medical and long-term care for Medicare-Medicaid “Dual Eligibles”. Poll results also gauge interest in reform if long-term services and supports were included.

Integrated Care Programs launched in five states in 2005 to coordinate acute and long-term services received by people enrolled in both Medicare and Medicaid. States were granted $100,000 and technical assistance focused on performance measurement, rate setting and risk adjustment, and administrative simplification. Here, state programs are evaluated, federal progress in integrated care is surveyed, and future considerations are identified.

Medicaid currently fills in the gaps in Medicare’s benefit package for 8.8 million enrollees with limited income and resources (dual eligibles). Shifting aspects of this financing to the Federal government could save states money and create opportunities for better care management and coordination. Data tables show how much each state could save if certain financing roles were shifted.