Dual Eligibles: Low-Income Medicare and Medicaid Beneficiaries

Low-income seniors and people with disabilities who receive Medicare and Medicaid (known as dual eligibles) should be able to access the health care and long term services and supports that they need. Through advocate trainings and administrative advocacy at the state and federal level, we work to remove barriers that exacerbate the disparities this group faces.

Dual eligibles are a diverse group, whose one underlying feature is poverty. Dual eligibles on average have higher health needs than other Medicare beneficiaries. They are also more likely to experience disparities in access to medical care due to language, sexual orientation, disability, or language barriers. They are more likely to be women and people of color than other Medicare beneficiaries. Their need for long-term services and supports is also greater. This is a population at great risk of experiencing life-threatening gaps in health care.

Under a provision of the Affordable Care Act, a ten states are implementing demonstrations that seek to integrate the delivery and financing of Medicare and Medicaid benefits by enrolling dual eligibles into private managed care plans. These demonstrations offer the promise of person-centered, integrated care for millions of poor seniors, but they also bring the risk that services will be cut and important protections lost in search of cost savings.

Justice in Aging works to protect dual eligibles entering these new programs by ensuring they are adequately informed of care changes; they retain access to doctors of their choice; they maintain services and care without disruptions; and they get help navigating an appeals system that honors their due process rights.

As national experts on issues affecting dual eligibles, Justice in Aging is an information hub for advocates and a feedback loop to policymakers implementing new programs. Advocates across the country rely on our resources and trainings to help them counsel the clients they serve directly. Last year alone we trained over 13,000 advocates and direct service providers on issues impacting dual eligibles. We meet regularly with health plan administrators and government agencies to share on-the-ground stories gathered from the advocates we train, and push for needed fixes to the program. We seek to ensure that new programs actually work as they should and also to fix longstanding dysfunctions in older continuing programs that keep dual eligibles from getting the services they need.

separate Justice in Aging website provides aging and disability advocates the information and tools they need to advocate for strong consumer protections in new dual eligible demonstrations. On this site, you’ll find reports, summaries, and comments on state proposals and plans, as well as state profiles and federal guidance. Recent work highlighted below.

National Resources

Ensuring Consumer Protection for Dual Eligibles in Integrated Models. Read the Brief.

Medicare and Medicaid Alignment: Challenges and Opportunities for Serving Dual Eligibles. Read the Brief.

Improving the Qualified Medicare Benefit Program for Dual Eligibles. Read the Brief.

Webinar: Dual Eligible Demonstrations, and Update for Advocates View the Webinar Info

Dual Eligibles California

Because California is one of the first states to implement a dual eligible demonstration, known as Cal MediConnect, and is home to 1.1 million economically vulnerable duals (more than any other state), California is a test case for the massive coordination effort. We’re heavily focused on training advocates all over the state to assist their clients as they transition into private health plans. Through this work, and our partnerships on the ground, we’re able to identify what’s working and not working and push for needed fixes to the program. Then we share our knowledge with advocates in other states to help them as their states roll out their own programs.

All California-specific tools can be found on the duals website. Recent work highlighted below.

Advocates Guide to the California’s Coordinated Care Initiative Version 4, coauthored with DREDF

Issue Brief: Culturally Competent Outreach Strategies in Health Care Transitions, coauthored with Advocates for African American Elders (AAAE)

Fact Sheet: Cal MediConnect: Continuity of Care

Coordinated Care Initiative Fix List – DOWNLOAD THE PDF

Webinar: The California Coordinated Care Initiative: Advanced Training Consumer Protections and Benefit Package Summary
View the Webinar Info

Fact Sheet: Balance Billing in California
READ THE PDF

Fix List June 2014: California Duals Program
A Fix List for tracking problems in the roll out of California’s Coordinated Care Initiative (CCI) was shared with the state’s Department of Health Care Services and CMS in June.

Webinar: The California Coordinated Care Initiative: What Advocates Need to Know: Basics  View the Webinar Info