Dual eligibles make up 14% of medicaid enrollment, yet they are responsible for approximately 36% of medicaid expenditures. This report explores dualeligible beneficiaries use of postacute care i. Dualeligible beneficiaries refers to those qualifying for both medicare and medicaid benefits. Ssi eligible children disabled children limited number of beneficiaries previously enrolled in fhp will be enrolled in the disabled children population managed longterm services and supports dual eligible beneficiaries not enrolled in the medicaremedicaid alignment initiative mmai demonstration limited managed care roll out in july 2016. Glossary of terms related to dualeligible beneficiaries. Beneficiaries dually eligible for medicare and medicaid january 2018 the role of medicare and medicaid for dual eligible beneficiaries medicare is the primary payer for dual eligible beneficiaries and mainly covers medical services such as. Under the program, contracted medicaremedicaid plans mmps in. Full dual eligible beneficiaries not enrolled in medicaid managed care. This highlight describes the characteristics and inpatient utilization of under age 65 disabled california medicare beneficiaries by dual eligible status i. Beneficiaries dually eligible for medicare and medicaid january 2017 medpac macpac 3 this data book is a joint project of the medicaid and chip payment and access commission macpac and the medicare payment advisory commission medpac.
It uses data from calendar year 2012 to examine beneficiary demographics, utilization and spending patterns, eligibility pathways, annual program growth rates and more. The chart book, maryland dual eligible beneficiaries. Beneficiaries dually eligible for medicare and medicaid january 2018 the role of medicare and medicaid for dualeligible beneficiaries medicare is the primary payer for dualeligible beneficiaries and mainly covers medical services such as. Models to improve dual eligible beneficiaries health outcomes. Dualeligibles make up 14% of medicaid enrollment, yet they are responsible for approximately 36% of medicaid expenditures. Dualeligible beneficiaries accounted for a disproportionate share of medicare spending, 2012 percent of ffs beneficiaries percent of ffs spending note. Medicare for coverage of most health care services and prescription medications, and. This includes full benefit dual eligible individuals and partial benefit dual eligible individuals i. Kaiser commission on medicaid and the uninsured, april 2012, table 2, p.
An overview medpac payment policies work for dual eligibles. The maryland dualeligible beneficiaries chart book explores. An overview of fy 2010 dual eligible beneficiary enrollment and spending who are the dual eligible beneficiaries. Dual eligible beneficiaries are individuals who are entitled to medicare and eligible for some level of assistance from their state medicaid program. Dec 27, 2018 with the lockin period in full swing, youre probably hearing more about dual eligible special needs plans dsnps lately. Under the program, contracted medicaremedicaid plans mmps in participating counties receive a capitated payment to provide. Disabled medicare beneficiaries by dual eligible status. Other state approachers to integrating medicare and. Dual eligibles qualify for benefits like the medicare part d low. The affordable care act of 2010 aca includes provisions related to the cost and quality of the care received by dually eligible medicare and medicaid beneficiaries. Aarp health insurance plans pdf download medicare replacement pdf download aarp medicarerx plans united healthcare pdf download medicare benefits pdf download. Facilitating community transitions for dually eligible.
The beginners guide to dsnps ritter insurance marketing. Beneficiaries dually eligible for medicare and medicaid, january 2015. Dual eligible dual eligible search results the henry j. Qmbs with full medicaid qmb plus these individuals are entitled to. Report to the ncga joint legislative oversight committee on medicaid and nc health choice on the managed care strategy for north carolina medicaremedicaid dual eligible beneficiaries. Challenges and opportunities for serving dual eligibles bevin prindiville and y k georgia burke nationa l senior citize ns law ce nter. Maryland fullbenefit dualeligible beneficiaries use of medicare and medicaid services preceding and following a medicare inpatient stay, characteristics of maryland fullbenefit dualeligible beneficiaries with three or more inpatient stays, and the maryland dualeligible beneficiaries chart book. Improving care and managing costs for dual eligibles national. Cy 2010 to cy 2012, provides an overview of maryland dual eligible beneficiaries with breakdowns by benefit category, age, race, gender, and. Sep 18, 2014 the affordable care act of 2010 aca includes provisions related to the cost and quality of the care received by dually eligible medicare and medicaid beneficiaries. Glossary of terms related to dualeligible beneficiaries of medicare and medicaid accountable care organizations. Analysis of dualeligible beneficiaries the hilltop institute. This chapter summary begins with highlights of characteristics and demographic.
Aug 28, 20 this brief examines the role of medicaid in providing health coverage to the 9. Tables 1 through 7 summarize the benefits and basic qualifications for each program. Analysis of dualeligible beneficiaries the hilltop. These dual eligible beneficiaries have complex and often costly health care needs, and have been the focus of many recent initiatives and proposals to improve the coordination of their care aimed. People eligible for both medicare and medicaid benefitsknown as dualeligible beneficiariesare a varied group, but many have extensive health care needs and account for a disproportionate share of spending on medicare and medicaid. Maryland dualeligible beneficiaries maryland medicaid. Medicare is a federal program that provides health nsurance coverage to. Options for integrating care for dual eligible beneficiaries. Full dual eligible beneficiaries who are not currently enrolled in a medicaid managed care health plan will have a 30day enrollment choice period in early calendar year 2018 if eligible to enroll in healthchoice illinois mltss. The chart book, maryland dualeligible beneficiaries. Dualeligible beneficiaries of medicare and medicaid. Org 1 foreword t his paper about differences in medicare and medicaid program rules and coverage standards is the second in a series of four papers. In cy 2012, marylands partialbenefit dualeligible beneficiariesdualeligible beneficiaries who did not qualify for full medicaid benefits but did receive assistance with medicare premiums and cost.
Other state approachers to integrating medicare and medicaid. Dual eligible beneficiaries under medicare and medicaid cms. Beneficiaries dually eligible for medicare and medicaid washington, d. Beneficiaries dually eligible for medicare and medicaid january 2017 about medpac the medicare payment advisory commission medpac is an independent congressional agency established by the balanced budget act of 1997 p. Whether youre new to dsnps or searching for information to finetune your selling techniques, this quick guide will. If the dsnp also operates an mmp in the county, d snp enrollees who are eligible are crosswalked into the. Maryland fullbenefit dualeligible beneficiaries use of. To be fidaeligible, must meet all four criteria enrollment into fida is optional beneficiaries will be automatically passively enrolled if they do not opt in or opt out beneficiaries can switch into, out of, or between fida plans up to once per month new york medicaid choice aka maximus 8884016582. Figures in bold reflect state penetration rates that are particularly low 5% or less for dsnp or dual eligible enrollment and 10% or less for other penetration rates. More disabled dually eligible beneficiaries are younger, nonwhite, and in. Dual eligible beneficiaries nder medicare and medicaid mln ooklet page 5 of 10 icn 006977 may 2018 medicare savings programs msps consider an individuals income and resources and other criteria.
In order to provide these beneficiaries with the right care at the right time in the right places, the center for health care strategies, inc. Starting in cy 2015 and continuing throughout the dual demonstration, dsnps affiliated with mmps that operate in dual demonstration service areas are not allowed to enroll beneficiaries eligible for the dual demonstration. This data book is organized into the following sections. Cy 2010 to cy 2012, provides an overview of maryland dualeligible beneficiaries with breakdowns by. The overview discusses and highlights changes that are expected to improve the potential for research on dual eligible issues. Consequently, when providers are not familiar with the demonstration, are not participating in health plan networks, or are wary about program policies, interviewees were less inclined to participate. Helping beneficiaries understand fully integrated dual. Aug 26, 2016 ltss and dual eligibles frequently asked questions aug. For state and federal policymakers, integrated care can potentially reduce fragmentation, increase flexibility in. Compared to the non dual medicare population, dual eligible beneficiaries are sicker, report lower health status, have lower functional status, and are more likely to be disabled. People dually eligible for medicare and medicaid fact. The maryland dual eligible beneficiaries chart book.
All states except illinois and minnesota also had small numbers of dually eligible beneficiaries enrolled in pace, up to 1% of dually eligible beneficiaries. Modernizing the medicare savings programs unlocking medicare and medicaid data to improve coordination of care. Beneficiaries dually eligible for medicare and medicaid january 2018 medpac macpac 3 this data book is a joint project of the medicaid and chip payment and access commission macpac and the medicare payment advisory commission medpac. Dual eligible dual eligible search results the henry. Dual eligibles advisory committee resources skip to main content. The hardcover of the dualeligible beneficiaries of medicare and medicaid. With the lockin period in full swing, youre probably hearing more about dual eligible special needs plans dsnps lately. Ltss and dual eligibles frequently asked questions aug. Dual eligible beneficiaries medicare dual eligibles or duals refers to those qualifying for both medicare and medicaid benefits. Groups of doctors, hospitals, and other health care providers who join together to provide coordinated care to a set of patients and who agree to be held accountable for the quality and total cost of those patients care. Overview of maryland dual eligible beneficiaries continued. There are nearly nine million dual eligible beneficiaries, and over 80 percent of these americans remain in uncoordinated feeforservice care. More disabled dually eligible beneficiaries are younger, nonwhite, and in feeforservice ffs than nondually eligible beneficiaries.
People dually eligible for medicare and medicaid fact sheet. Medicaids role for dualeligible beneficiaries the henry j. Whether youre new to dsnps or searching for information to finetune your selling techniques, this quick guide will cover all the basic information you need to know about these valuable, multifaceted products. Overview of state dual eligible capitatedadministrative alignment demonstrations approved by cms. Dualeligible beneficiaries of medicare and medicaid jun 6, 20 dualeligible beneficiaries is paid by medicaid, and those payments are counted improve the quality of care for dualeligible beneficiaries. Dualeligible beneficiaries accounted for a disproportionate share of.
Both medicare and medicaid cover home health services. Dual eligibles 4 when medicare offers little or no coverage of a particular service, and the medicare provider does not know if the service is offered under medicaid, the dual eligible individual may face a different coordination. Dual eligible beneficiaries of medicare and medicaid. Medicare part a, have income of 100% fpl or less and resources that do not exceed twice. Authorized under title xix of the social security act, medicaid is a meanstested. Dualeligible beneficiaries medicare dual eligibles or duals refers to those qualifying for both medicare and medicaid benefits.
This guide provides an overview of dualeligible beneficiaries who receive benefits from both medicare and medicaid. These issues are of particular concern given the high health needs of dually eligible beneficiaries and the fact that this group accounts for a disproportionate share of both medicare and medicaid spending. Cy 2010 to cy 2012, provides an overview of maryland dualeligible beneficiaries with breakdowns by benefit category, age, race, gender, and county of residence. People with complex medical needs can choose to live and receive care.
The maryland dualeligible beneficiaries chart book provides an overview of maryland dualeligible beneficiaries with breakdowns by benefit category, age, race, gender, and county of residence. An examination of services and spending for people eligible for both medicare and medicaid. Beneficiaries dually eligible for medicare and medicaid. Dualeligible beneficiaries are challenged by the need to navigate two separate programs. Jan 31, 2017 report to the ncga joint legislative oversight committee on medicaid and nc health choice on the managed care strategy for north carolina medicaremedicaid dual eligible beneficiaries. Medicaid managed longterm services and supports mltss. Cy 2010 to cy 2012, provides an overview of maryland dualeligible beneficiaries with breakdowns by benefit category, age, race, gender, and.
Dual eligible beneficiaries are designated as such if the months they were enrolled in medicaid exceeded the months they were enrolled in supplemental insurance. The findings provide an overview of how this population accesses health care services, the types of services used, and where the services are provided. Health care spending and the medicare program, june 2016 35. Compared to the nondual medicare population, dual eligible beneficiaries are sicker, report lower health status, have lower functional status, and are more likely to be disabled. Beneficiaries dually eligible for medicare and medicaid december 20 about medpac the medicare payment advisory commission medpac is an independent congressional agency established by the balanced budget act of 1997 p. What is the frequency with which specific pathways to dual eligible. The kaiser family foundation website provides indepth information on key health policy issues including medicaid, medicare, health reform, global health, hivaids, health insurance, the uninsured. Dual eligible beneficiaries under medicare and medicaid. This data book was jointly produced by the medicaid and chip payment and access commission macpac and the medicare payment advisory. In april 2014, california implemented the cal mediconnect demonstration under the federally authorized financial alignment initiative fai for dually eligible individuals in seven of its counties. Cms is committed to better care for dually eligible individuals. Medicare acts as a primary payer for these people, providing coverage for a. Spending growth for dualeligible beneficiaries has trended down since. For dual eligible beneficiaries, integrated care potentially offers one seamless set of benefits and providers, higher quality of care, and less confusion figure 1.
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