Dual Eligibles

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Transitions from Medicare-Only to Medicare-Medicaid Enrollment

This study focuses on understanding the rates and patterns of enrollment in Medicaid among individuals already enrolled in Medicare, the factors that predict this transition to dual coverage, and those that predict nursing home entry. This volume of this report is a descriptive examination of the number and characteristics of Medicare beneficiaries who transition to dual coverage in the coming year.

Short URL: http://www.advancingstates.org/node/65916

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Factors Predicting Transitions from Medicare-Only to Medicare-Medicaid Enrollee Status

This study focuses on understanding the rates and patterns of enrollment in Medicaid among individuals already enrolled in Medicare, the factors that predict this transition to dual coverage, and those that predict nursing home entry. This volume provides estimated econometric models that predict beneficiaries' enrollment in Medicaid, and their entry into long-term nursing home stays.

Short URL: http://www.advancingstates.org/node/65902

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Effect of PACE on Costs, Nursing Home Admissions, and Mortality: 2006-2011

This report developed new estimates of the program's effects for Program of All-Inclusive Care for the Elderly (PACE) enrollees in eight states based on more recent data. PACE plans provide coordinated acute and long-term care services to nursing home eligible seniors residing in the community.

Short URL: http://www.advancingstates.org/node/65901

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An Investigation of Interstate Variation in Medicaid Long-Term Care Use and Expenditures Across 40 States in 2006

Shifting the balance in publicly-funded long-term care provision away from institutional care toward greater reliance on home and community-based services has been a federal goal for the past three decades -- a goal often referred to as "re-balancing" state LTC systems. This report explores inter-state variations in LTC expenditure and service use patterns, in terms of institutional and non-institutional services, and also by Medicaid LTC users' age and type of disability.

Short URL: http://www.advancingstates.org/node/65900

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Disabled Dual-Eligible Beneficiaries: Integration of Medicare and Medicaid Benefits May Not Lead to Expected Medicare Savings

In this report, the GAO examined claims, expenditure, and quality data from Dual Eligible Special Needs Plans (D-SNPs) during 2009. The GAO notes that D-SNPs with higher levels of Medicare and Medicaid integration performed better on quality outcomes but did not reduce utilization of costly Medicare services. The GAO concludes that CMS projected savings from the Financial Alignment Demonstration and other initiatives to integrate care for dual eligible beneficiaries may be overstated.

Short URL: http://www.advancingstates.org/node/65894

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Evaluating PACE: A Review of the Literature

This report brings together available evidence on the effect of PACE on several key outcomes: Medicare and Medicaid costs, hospital and nursing home utilization, quality of care, satisfaction and quality of life, and mortality. The authors summarize findings from past studies and assess their methodological approach. They improve on these earlier evaluations by conducting a more detailed review of the studies, as well as a more rigorous assessment of the quality of evidence presented in each.

Short URL: http://www.advancingstates.org/node/65892

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Resources for Integrated Care and Quality

CMS developed a web page of resources for integrated care available for health plans and providers. CMS has been supporting efforts to build provider and health plan capacity to deliver more integrated and coordinated care to Medicare-Medicaid enrollees. These resources are targeted to various types of organizations, including behavioral health providers, health plans, long-term service & support providers. Review the technical assistance and actionable tools developed.

Short URL: http://www.advancingstates.org/node/65538

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State Medicaid Directors Letter: Application of Liens, Adjustments and Recoveries, Transfer-of-Asset Rules and Post-Eligibility Income Rules to MAGI Individuals

This letter provides guidance to states on how the long-term services and supports-related rules, including the estate recovery rules, in section 1917 of the Social Security Act (the Act), and federal regulations at 42 C.F.R. 435.700, et seq., apply to individuals who are eligible for Medicaid under Modified Adjusted Gross Income (MAGI) eligibility rules (“MAGI individuals”) and receive coverage for long-term services and supports (LTSS).

Short URL: http://www.advancingstates.org/node/61324

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Application of Existing External Quality Review Protocols to Managed Long Term Services and Supports

This guidance document is intended to provide guidance to states on how to apply the revised protocols for External Quality Review (EQR) of Medicaid managed care organizations, released in 2012, to managed long term services and supports (MLTSS) programs. Although the protocols already apply to MLTSS generally, this document offers specific suggestions to make their application to long term services and supports (LTSS) clearer and provides suggestions, examples and illustrations.

Short URL: http://www.advancingstates.org/node/60531

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