Dual Eligibles

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Coordinating Physical and Behavioral Health Services for Dually Eligible Members with Serious Mental Illness

This case study examines the benefits of coordinating care for dually eligible members with serious mental illness. It looks specifically at how one Pennsylvania plan used a robust care coordination and member engagement model to successfully reduce urgent and unplanned inpatient admissions; and optimize health outcomes, quality of life, and self-management skills for individuals with serious mental illness.

Short URL: http://www.advancingstates.org/node/71857

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Facilitating Community Transitions for Dually Eligible Beneficiaries

This case study explores how health plans can help rebalance LTSS for dually eligible members. It looks at two California health plans who successfully transitioned dually eligible members from institutional to community settings. The case study uses these two examples to identify key elements for supporting dually eligible individuals with LTSS needs during the transition to living in the community.

Short URL: http://www.advancingstates.org/node/71856

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The Value of Pursuing Medicare-Medicaid Integration for Medicaid Agencies

This report is the fourth in a series of publications from the MLTSS Institute, which was established in 2016 to drive improvements in key MLTSS policy areas, facilitate sharing and learning among states, and provide direct and intensive technical assistance to states and health plans. This issue brief focuses on delivering effective care to individuals eligible for both Medicare and Medicaid and aims to lay out the case for state Medicaid agencies to invest in integrated care programs.

Short URL: http://www.advancingstates.org/node/71835

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Enticing Dually Eligible Beneficiaries to Enroll in Integrated Care Plans

The Financial Alignment Initiative (FAI) is intended to improve the quality of care and reduce spending for low-income people who are dually eligible. Mathematica researchers conducted a study to identify reasons for the varying participation rates across states. This brief explores the details of two major factors: passive enrollment and demonstration/MLTSS alignment.

Short URL: http://www.advancingstates.org/node/71771

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HCBS Conference 2019- Presentations

The Home and Community Based Services (HCBS) Conference is hosted annually by ADvancing States (formerly known as NASUAD). This event highlights best practices from across the country in home and community-based services. The conference includes federal, state, and local policymakers as well as those who administer, manage, and deliver waiver and other HCBS programs. This link contains all of the slide presentations from the 2019 HCBS Conference.

Short URL: http://www.advancingstates.org/node/71741

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Information Sharing to Improve Care Coordination for High-Risk Dual Eligible Special Needs Plan Enrollees: Key Questions for State Implementation

This technical assistance tool focuses on the new “information sharing” requirement for Dual Eligible Special Needs Plans beginning in 2021. The tool explains the new requirement as well as how to address the requirement in mandatory D-SNP contracts.

Short URL: http://www.advancingstates.org/node/71731

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Changes to Modified Adjusted Gross Income (MAGI)-based Income Methodologies

The Centers for Medicare & Medicaid Services issued a State Health Official letter that provides guidance on legislative changes to the modified adjusted gross income (MAGI)-based methodologies used for determining Medicaid and CHIP eligibility. In order to implement the changes to MAGI-based methods, states may need to update eligibility policies and procedures and make changes to eligibility systems logic.

Short URL: http://www.advancingstates.org/node/71708

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Selected Characteristics of 10 States With the Greatest Change in Long-Term Services and Supports System Balancing, 2012–2016

The Centers for Medicaid & Medicare Services released a report that profiled the 10 states with the greatest change in Long-Term Services and Support (LTSS) system balancing. The report highlights characteristics of the 10 states and compares their change in LTSS system balancing with other states and provides a national overview on LTSS system balancing. State profiles consist of characteristics and strategies states utilized in their progress towards rebalancing their LTSS systems.

Short URL: http://www.advancingstates.org/node/71673

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