Brief

Using Default Enrollment to Align Coverage for Dually Eligible Medicare-Medicaid Beneficiaries

States can allow or require D-SNPs that meet certain requirements to use default enrollment to align Medicare and Medicaid coverage for dually eligible individuals. Under default enrollment, D-SNPs may automatically enroll individuals who are enrolled in a comprehensive Medicaid managed care organization offered by the same parent organization as the D-SNP when those individuals first become eligible for Medicare Parts A and B (at the same time) due to age or disability.

Preventing and Addressing Unnecessary Medicaid Eligibility Churn Among Dually Eligible Individuals: Opportunities for States

People who are dually eligible for Medicare and Medicaid benefits often have multiple chronic physical and behavioral health conditions, and many use long-term services and supports (LTSS).1 Unfortunately, a relatively high proportion of dually eligible individuals cycle in and out of Medicaid eligibility, often due to lack of response to state Medicaid renewal notices. This creates disruptions in coverage and care, which can result in adverse health outcomes and increased costs for individuals and states. 

State Approaches to Developing and Operating Ombudsman Programs for Demonstrations under the Financial Alignment Initiative

Ombudsman programs can offer beneficiary protections as part of Medicaid managed care programs. These programs are particularly important for beneficiaries with complex physical and behavioral health conditions, including many dually eligible individuals. For the demonstrations under the Financial Alignment Initiative, the Centers for Medicare & Medicaid (CMS) and states incorporated ombudsman programs to help to resolve enrollees’ problems and alert Medicare-Medicaid Plans (MMPs), states, and CMS of emerging trends and issues.

Information Sharing to Improve Care Coordination for High-Risk Dual Eligible Special Needs Plan Enrollees: Key Questions for State Implementation

Starting January 1, 2021, Coordination Only (CO) Dual Eligible Special Needs Plans (D-SNPs) are required to notify the state Medicaid agencies that they contract with (or the states' designees) of hospital and skilled nursing facility admissions for at least one specified group of high-risk full benefit dually eligible individuals.  This ICRC technical assistance tool provides key questions and considerations for states as they develop contract requirements for these D-SNPs.

Promoting Information Sharing by Dual Eligible Special Needs Plans to Improve Care Transitions: State Options and Considerations

This brief examines the approaches used by three states – Oregon, Pennsylvania, and Tennessee – to develop and implement information-sharing processes for their Dual Eligible Special Needs Plans (D-SNPs) that support care transitions. The brief includes examples of contract language and strategies to encourage plan collaboration and problem solving around information sharing.

Building a Stronger Foundation for Medicare- Medicaid Integration: Opportunities in Modifying State Administrative Processes

This brief describes several administrative changes that state Medicaid programs can make to: (1) support integration efforts; (2) improve beneficiaries’ experience of care; (3) decrease beneficiary out-of-pocket costs; and (4) reduce provider burden. Taking the steps described in this brief may help states build stronger, more effective integrated care programs and better position them to implement larger-scale integration efforts for their dually eligible populations.