Dual Eligibles

On January 31, the Centers for Medicare & Medicaid Services (CMS) released the latest enrollment figures for Medicare, Medicaid, and CHIP. As of October 2023, over 66.6 million people are enrolled in Medicare; more than 34 million are enrolled in fee-for-service Medicare, and close to 32.6 million are enrolled in Medicare Advantage or other health plans. Over 87.2 million enrollees have Medicaid and CHIP. More than 80.2 million individuals have Medicaid and over 7 million have coverage through CHIP. Over 12 million individuals are dually eligible for Medicare and Medicaid and are counted in the enrollment figures for both programs.

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.

On Thursday, February 24, 2022, CMS released a CMCS Informational Bulletin with the updated 2022 Federal Poverty Level Standards. The 2022 guidelines reflect the 4.7 percent price increase between calendar years 2020 and 2021. After this inflation adjustment, the guidelines are rounded and adjusted to standardize the differences between family and household sizes. The informational bulletin also includes a 2022 Dual Eligible Standards chart that displays the new standards for the Medicare Savings Program categories.

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.

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.

ATI Advisory released extensive data analysis of Medicare claims data to highlight the disparate impact of the COVID-19 pandemic on individuals eligible for both Medicare and Medicaid (dual eligibles).The analysis also offers policy pathways for states to improve integrated care for this vulnerable population.

CHCS and Speire Healthcare Strategies released a report about COVID-19 response efforts from states and health plans that offer integrated care programs for duals. People who are dually eligible for Medicare and Medicaid are among the nation’s most vulnerable to the coronavirus. The report outlines opportunities to support integration and identifies opportunities to strengthen programs and policies to best support the dual eligible population during the pandemic and in the future.

This issue brief from the MLTSS Institute focuses on aspects of delivering effective care to individuals eligible for both Medicare and Medicaid (dually eligible individuals).The brief provides a primer on the ways that Medicare data can help states better deliver care to dually eligible individuals; it also details information about data sources and other resources available to help obtain and analyze Medicare data.

Justice in Aging published a new brief centered on the dual eligible population and programmatic recommendations to support equity. The recommendations are measures advocates and health plans can use to ensure equity is at the center of the response to COVID-19. Examples of recommendations in the brief include: Expanding/targeting outreach for COVID-19 and routine care based on information plans have about their members; Prioritizing HCBS and support for caregivers; Enhancing data collection

This brief draws from interviews with states operating new and long-standing MLTSS programs to identify six major trends in the refinement of MLTSS and underlying LTSS delivery systems nationally. The states examined in this brief are strengthening their Medicaid MLTSS programs to serve more LTSS beneficiaries and facilitate the development of integrated care programs that reduce service fragmentation for Medicare-Medicaid enrollees, particularly through Medicare Advantage D-SNPs