Dual Eligibles

With the passage of the Affordable Care Act (health reform), there is renewed attention to the lack of coordinated care for those with both Medicare and Medicaid.  Through administrative advocacy, we seek to ensure that the Medicare-Medicaid Coordinating Office (MMCO) within the U.S. Department of Health and Human Services focuses its efforts on improving care for the nation’s roughly 9 million dual eligibles.

Dual elgibles as a group have higher health needs and lower incomes than other Medicare beneficiaries. They are also more likely to need long term services and supports.

In 2011, NSCLC issued a number of issue briefs on topics related to integrated models of care envisioned under the health reform law:

•  Consumer Protection for Dual Eligibles Important in New Integrated Care Models
•  Building an Integrated Appeals System for Dual Eligibles
•  Medicare and Medicaid Alignment: Challenges and Opportunities for Serving Dual Eligibles  
•  Improving the Qualified Medicare Beneficiary Program for Dual Eligibles

• Prindiville Addresses Policy Forum on Consumer Protection for Duals
  More than 150 health policymakers, Congressional staff and government officials heard NSCLC Deputy Director call for strong consumer protection for dual eligibles in new integrated models under development in many states.  He was joined by MMCO Direc...



• Comments: California’s Dual Eligibles Demonstration Project
  (1/9/12)  In a letter to the director of the California Department of Health Care Services, NSCLC Deputy Director writes that the proposed solutions fall short by simply expanding enrollment in existing medical-focused managed care systems. READ MORE



• No Part D Copayments for Medicaid HCBS Duals
  Effective January 1, 2012, full-benefit dual eligibles receiving Medicaid home and community based services (HCBS) have no Medicare Part D copayments READ MORE -- Information for Advocates. CMS Memo on Part D Waiver for Dual Eligibles.  



• Dual Eligibles Fact Sheet
  Who are dual eligibles? What are the challenges and recommendations needed to protect their rights as new integrated models are under consideration? Read the Fact Sheet.



• Prindiville Testified Before the California Joint Oversight Hearing of the Senate and Assembly Health Committees
  (12/7/11) Deputy Director Kevin Prindiville testified before the California Joint Oversight Hearing of the Senate and Assembly Health Committees on Ensuring Consumer Protection of Dual Eligibles in Integrated Models. Listen to his testimony: [audio...



• Fact Sheet: Dual Eligibles
  Read the fact sheet  



• Dual Eligible Sign On Letter to Super Committee
  (11/14/11) NSCLC joined more than 50 consumer, provider, labor and other interest groups on a letter to the Congressional supercommittee urging them to carefully consider imposing a "one size fits all" on dual eligibles and cautioning them about imposi...



• QMB Program Needs Fixes to Operate Effectively
  (11/16/11) A new issue brief from NSCLC says that dual eligibles who qualify for the Qualified Medicare Beneficiary (QMB) program often go without needed care because they can’t find physician specialists, mental health professionals or other provide...



• Webinar: Improving the Qualified Medicare Beneficiary Program for Dual Eligibles
  (11/16/11) The Qualified Medicare Benefit (QMB) was created to give low income people with Medicare full access to Medicare providers without liability for premiums and co-pays.  But the program fails to deliver the benefits it promises.  QMB benefic...



• Appeals Processes Need to be Integrated for Dual Eligibles
  (10/4/11) An issue brief from the National Senior Citizens Law Center entitled “Building an Integrated Appeals System for Dual Eligibles,” recommends that as the Centers for Medicare and Medicaid Services (CMS) works with states to create new model...