Dual Eligibles

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.

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 issue brief from the MLTSS Institute focuses on aspects of delivering effective care to individuals eligible for both Medicare and Medicaid. Only about 2/3 of states have undertaken any activity to better integrate care for dually eligible beneficiaries; many have encountered a number of barriers in pursuing better integration of the Medicare and Medicaid programs. This issue brief identifies key questions that states should ask themselves before they design an integrated care program.

This brief looks at states who operate Medicare-Medicaid integrated care models based on demonstrations under the federal Financial Alignment Initiative (FAI) or through Dual Eligible Special Needs Plans (D-SNPs) that are aligned with Medicaid managed care plans. It explores factors that contributed to state investment and successful program implementation. The brief also provides an overview of opportunities for other states interested in creating or enhancing integrated care programs.

This report presents highlights from a National Governor's Association Roundtable held in December 2018. At the roundtable, state and federal officials, national experts, and industry and consumer experts discussed challenges and opportunities for states to improve care and manage costs for dual eligibles. Based on the conversation at this event, NGA identifies key considerations for governors and their staff.

This case study examines the benefits of coordinating care for dually eligible members with serious mental illness. It looks specifically at how one Pennsylvania plan used a robust care coordination and member engagement model to successfully reduce urgent and unplanned inpatient admissions; and optimize health outcomes, quality of life, and self-management skills for individuals with serious mental illness.

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 study used mystery shoppers in six states to asses the accuracy of PACE awareness in counselors supporting LTSS beneficiaries. This 2018 study focuses on a range of information and referral/assistance entities.