Dual Eligibles

To understand both the needs of people who use long-term services and supports (LTSS) through Medicare and Medicaid coverage and ways to apply quality measurement to this population, the National Committee for Quality Assurance (NCQA), supported by The SCAN Foundation, developed a roadmap for evaluating the quality of integrated care for dual eligibles.

The CMS Medicare-Medicaid Coordination Office (MMCO) regularly reports data on Medicare-Medicaid enrollee demographics, service utilization, spending, and other characteristics that can give states a more comprehensive view of this population. This tool shows states how to use these data to create tables, graphs, and figures and interpret their meaning for a wider audience of stakeholders.

This brief from the SCAN Foundation summarizes lessons learned and offers recommendations for improving integrated systems of care for people with Medicare and Medicaid, also known as dually eligible individuals. The brief draws from three years of California’s Cal MediConnect evaluation results.

The Integrated Care Resource Center published an issue brief about the issues and options that states have when contracting with Medicare Advantage Dual Eligible Special Needs Plans.

The Center for Health Care Strategies (CHCS) published their report, “ACAP Medicare-Medicaid Plans and the Financial Alignment Demonstrations: Innovations and Lessons”, that was prepared for the Association for Community Affiliated Plans (ACAP). The report examines the experiences of 14 ACAP plans that are participating in capitated model demonstrations for the Centers for Medicare & Medicaid (CMS) Financial Alignment Initiative.

The Department of Health and Human Services (HHS) published a report about the Minnesota Senior Health Options (MSHO) program. The Centers for Medicare and Medicaid Services (CMS) and the State of Minnesota started MSHO to coordinate the Medicare and Medicaid benefits their members receive, including Medicare coverage of acute medical care and Medicaid coverage of long-term services and supports. The report includes documentation of MSHO's outcomes from years 2010 to 2012.