Medicaid Arrangements to Coordinate Medicare and Medicaid for Dual-Eligible Individuals
This issue brief describes how state Medicaid programs are implementing arrangements aimed at coordinating Medicare and Medicaid for dual-eligible individuals.
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The Connection Between Social Security Disability Benefits and Health Coverage Through Medicaid and Medicare
Issue BriefThis analysis examines who was eligible for Medicare and/or Medicaid between 2002 and 2022 because they received disability benefits from one of the country's Social Security disability programs, Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). Many who receive SSDI and SSI qualify for both Medicare and Medicaid, known as dual-eligible individuals.
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A Closer Look at the Growing Role of Special Needs Plans in Medicare Advantage
Issue BriefTo better understand the growing role of Special Needs Plans (SNPs) in Medicare Advantage, this brief examines SNP enrollment trends using recent Medicare Advantage enrollment data published by the Centers for Medicare and Medicaid Services (CMS).
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Dual Eligible Demonstrations: The Beneficiary Perspective
Issue BriefThis issue brief provides insights about initial implementation of the financial alignment demonstrations from the perspective of dual eligible beneficiaries in Massachusetts, Ohio, and Virginia, based on 12 individual interviews conducted in early 2015. Profiles of six beneficiaries are presented to illustrate representative program experiences, along with key findings from across all of the interviews.
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Early Insights from One Care: Massachusetts’ Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries
Issue BriefMassachusetts is among the early states to launch a 3-year capitated financial alignment demonstration to integrate payments and care for beneficiaries who are dually eligible for Medicare and Medicaid. This case study describes the early implementation of the demonstration based on a diverse group of stakeholder interviews.
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Demonstrations to Improve the Coordination of Medicare and Medicaid for Dually Eligible Beneficiaries: What Prior Experience Did Health Plans and States Have with Capitated Arrangements?
ReportThis report examines the Center for Medicare and Medicaid Services (CMS) financial alignment demonstration for beneficiaries dually eligible for Medicare and Medicaid, with a focus on the extent to which participating states and health plans have prior experience with capitated managed care arrangements under Medicare or Medicaid, and specifically for this population. Under these capitated financial alignment demonstrations, health plans contract with the state and CMS (a three-way contract) to provide both Medicare and Medicaid benefits to dually eligible beneficiaries. These demonstrations aim to improve the quality of care and the coordination of benefits for people dually eligible for Medicare and Medicaid. The report finds considerable variation in the experience of states and health plans participating in these demonstrations, and discusses the potential implications for beneficiaries and plan oversight.
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Comparison of Consumer Protections in Three Health Insurance Markets: Medicare Advantage, Qualified Health Plans and Medicaid Managed Care Organizations
ReportThis report examines similarities and differences in federal consumer protection standards for Medicare Advantage (MA) plans, Qualified Health Plans (QHPs), and Medicaid Managed Care Organizations (MCOs). It focuses on rules established at the federal level, though some states have chosen to go above the federal minimums and impose additional requirements for QHPs and Medicaid MCOs.
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9 Million Dual Eligible Beneficiaries are Covered by Both Medicare and Medicaid
FeatureThis slide shows how many people are covered by both Medicare and Medicaid.
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The Role of Health Coverage for People with Disabilities
Event Date:EventPeople with disabilities are at risk in the health-care system because of their wide-ranging health-care needs, their relatively heavy use of prescription drugs, health-care and support services, and typically low incomes. A new survey of people with permanent mental and/or physical disabilities explores their health-care experiences and challenges in accessing and paying for care.
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Increasing Medicaid Payments for Certain Primary Care Physicians in 2013 and 2014: A Primer on the Health Reform Provision and Final Rule
Issue BriefTo help ensure that access in Medicaid expands to meet anticipated higher demand for care, the health reform law requires states to pay certain physicians Medicaid fees that are at least equal to Medicare’s for a list of 146 primary care services in 2013 and 2014.