Your Source for Health Reform

Topic: Dual Eligibles

Dual-eligible beneficiaries are those qualifying for both Medicare and Medicaid. About 9 million people fall into this category, including low-income seniors and younger people with disabilities. They tend to have complex and costly health care needs.

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Managed Long Term Services and Supports

Starting July, 2016 managed care organizations will be responsible for coordinating long-term services and supports for people who live in a nursing facility or receive home and community-based services through a Medicaid waiver program. This April 2016 fact sheet from Health & Disability Advocates informs consumers about the change.

ACEs, Bs and CCEs

This December 2014 FAQ from the Illinois Department of Human Services details general enrollment and access to care procedures for consumers and providers in Medicaid managed care.

Do New Health Delivery Models Really Deliver?

This December 2015 report from Community Catalyst provides policy and operational recommendations that promote person-centered and coordinated care in dual-demonstration programs.

Targeting the Social Determinants of Health

This December 2015 brief from the Center for Health Care Strategies explores approaches to using Medicaid funding for non-medical services. The approaches are  utilized as part of state-based coordinated care initiatives.

Keep Calm and Transition On

This November 2015 toolkit from the Medicare-Medicaid Coordination Office will help people with mental health conditions transition from one care provider to another. Strategies are offered for overcoming barriers to care and for strengthening relationships between the person’s care team members.

Mobile and in MMAI

This June 2015 FAQ from EverThrive reviews enrollment policies concerning Medicaid managed care beneficiaries who move to a different county.

Effective Health Care Outreach

This September 2015 brief from the Center for Health Care Strategies presents approaches for engaging with Medicaid and Medicare eligible health care consumers. This group is more likely to have chronic health conditions and is harder to engage.

Maneuvering the Medicare and Medicaid Maze

This July 2015 report from Health & Disability Advocates and the Make Medicare Work Coalition shares the experiences of professionals in helping older adults and people with disabilities navigate the health care system. The report is based on a survey of MMW membership that covered topics including Medicare and Medicaid enrollment, Medicaid redeterminations, and Medicaid managed care.

Ombudsman Contact Information 

The Home and Community Ombudsman program is a free service for enrollees in the Medicare Medicaid Alignment Initiative. Ombudsman advocate for enrollee rights and solve problems with their services. This 2015 information sheet tells who to call for Ombudsman services.

What Happens After Enrolling in Medicaid Coordinated Care?

This May 2015 timeline from Health & Disability Advocates and the Make Medicare Work Coalition outlines what  enrollees should expect from their managed care plans.

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