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.

KFF has released an issue brief that describes how state Medicaid programs are implementing arrangements aimed at coordinating Medicare and Medicaid for dual-eligible individuals. Dual-eligible individuals receive their primary health insurance coverage through Medicare and receive additional assistance from their state Medicaid program. The brief reports that nearly all states are leveraging strategies to coordinate care for dual-eligible individuals and many states are using multiple strategies.

the MMCO submitted its FY 2022 Medicare-Medicaid Coordination Office Report to Congress, as required by statute. Federal statute established the Federal Coordinated Health Care Office or MMCO within CMS to improve the coordination between the federal government and states to enhance access to quality services for individuals dually eligible for both Medicare and Medicaid benefits. The report describes MMCO’s activities to better serve dually eligible individuals in 2022 and contains three legislative recommendations, which were proposed in the Presidents Fiscal Year (FY) 2024 Budget.

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.

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.

In this blog post, Nancy Archibald, MHA, MBA, Associate Director of Integrated Care at CHCS, describes the state of Indiana's plan to launch Medicaid managed long-term services and supports in 2024. The state is receiving grant funding through Advancing Medicare & Medicaid Integration, an Arnold Ventures initiative developed in partnership with CHCS that assists states in filling resource gaps in designing and launching integrated care programs.

NCOA, in partnership with the Medicare Rights Center, recently expanded the resources in their toolkit that help explain integrated care coverage options for dual eligibles. New items in the toolkit include a video tutorial explaining integrated care, an infographic for counselors, and comparison charts highlighting the differences between Original Medicare, PACE, Duals Special Needs Plans (D-SNPs) and integrated D-SNPs.

Justice in Aging's new fact sheet, Investing in Medicaid HCBS is Good for Medicare, explains why investing in Medicaid HCBS is good for people with Medicare and the Medicare program. Robust funding for Medicaid HCBS would expand access to services, helping people with Medicare who are dually eligible for Medicaid avoid hospitalizations and other costly care.

NCOA has partnered with the Medicare Rights Center to develop a toolkit for counselors who work with dual eligibles and beneficiaries themselves. This toolkit was created following interviews and focus groups with counselors and will be updated continually.

Dual eligibles for Medicare and Medicaid have higher levels of chronic pain and use prescription opioids to treat pain more often than those eligible for Medicare only, putting them at a higher risk for opioid misuse or addiction. This brief presents examples of multimodal pain management options that clinicians can consider for treating pain among dually eligible individuals. The resource describes various treatment options, key evidence, and prescribing considerations for each option.