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.

There is a lot of current state activity around demonstration projects to integrate Medicare and Medicaid services. A  separate NSCLC website provides aging and disability advocates the information and tools they need to ensure that models for delivering health and long term servcies and supports to dual eligibles include strong consumer protections. Visit the site to access recent advocate comments, state profiles and federal guidance.

Dual eligibles 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

• Over 100 Ask MMCO for Ombudsman in Duals Demonstration Projects
  An impressive list of 103 organizations joined a sign-on letter that NSCLC and the National Committee to Preserve Social Security and Medicare drafted that urges the Medicare Medicaid Coordinated Office at the Centers for Medicare and Medicaid services...



• CMS Approves New York Transfer of Medicaid LTSS into Managed Care
  On August 31, 2012, the Center for Medicare and Medicaid Services (CMS) agreed to amend both of its managed care demonstrations to include long-term services and supports (LTSS) on a mandatory basis.  As part of the approval, CMS amended the Special T...



• Webinar – Dual Eligible Demonstrations: A Critical Moment
  August 22, 2012 Webinar. Twenty-six states have submitted proposals to the Centers for Medicare and Medicaid Services (CMS) to integrate the delivery and financing of services for people that qualify for both Medicare and Medicaid (dual eligibles). ...



• Assessing the Quality of California Dual Eligible Demonstration Health Plans
  (May 2012) This report contains an analysis of the eight health plans selected by the California Department of Health Care Services and finds that seven of the eight received a global health plan rating of 1 (poor) out of five (excellent) stars. &n...



• NSCLC Launches New Website about Dual Eligible Demonstrations
  The National Senior Citizens Law Center has launched a new website to provide aging and disability advocates the information and tools they need to ensure that models for delivering health and long term services and supports to dual eligibles (people w...



• 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...