The Dual Eligible Demonstration at Five:
Justice in Aging Toolkit on Design and Implementation

Five years ago, under a provision of the Affordable Care Act (Pub. Law 111-148, Section 2602), Centers for Medicare and Medicaid Services (CMS) created a new office to focus exclusively on individuals who qualify for Medicare and Medicaid, dual eligibles. The new entity, the Medicare-Medicaid Coordination Office, began working with states across the country to better align Medicare and Medicaid benefits through state-run dual eligible demonstrations. 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.

Currently, 11 states are in various stages of implementing the demonstration. Five states (Massachusetts, Ohio, Illinois, California and Virginia) are at least one year into delivering benefits through managed care, as part of the demonstration’s capitated model. Four states (Michigan, Texas, South Carolina, and New York) launched their capitated demonstration this year. Two states (Washington and Colorado) are delivering services through a managed fee-for-service program. 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.

States and CMS are in the early stages of evaluating the demonstration and also looking at mid-course corrections and improvements based on experience to date. At the same time, advocates and policymakers are contemplating future health care delivery system reforms, as part of a broader reform effort to pay for value and outcomes, instead of volume.

To contribute to these efforts, Justice in Aging created the following toolkit of design and implementation resources. The toolkit consists of:

  • A new tool for advocates comparing different state outreach and enrollment materials to highlight effective models to use when reaching vulnerable populations.

  • Resources on appeals procedures, designing enrollment notices, care continuity, and ensuring consumer protections in integrated models. These resources were developed earlier by Justice in Aging to influence the demonstration’s design to ensure consumer protections were a focus of new managed care delivery systems and are assembled together as part of the toolkit.