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Medicare and Dual Eligible

Dual Eligibles

New Long-Term Services and Supports in Managed Care
Source: NSCLC
Content Type: Website Toolkit for advocates related to long-term services and supports (LTSS)-specific beneficiary protections.
A growing number of states are proposing to place the responsibility for providing long-term services and supports to seniors and people with disabilities under managed care organizations (MCOs). Strong beneficiary protections specific to the delivery of LTSS must be incorporated to ensure that states and MCOs develop models that best supports independence and the ability of beneficiaries. Developed in partnership with the Disability Rights Education and Defense Fund (DREDF), the toolkit provides ideas for LTSS beneficiary protection that state advocates can use to push for strong protections in managed LTSS programs. Included in the toolkit are general summaries about their context and specific ideas that could be incorporated into developing models. Topics covered include consumer protections and opportunities in 15 different areas from managed care context to HCBS benefit packages to person-centered care planning and self direction.

Dual Eligible Integrated Care Demonstrations
Source: NSCLC
Content Type: Interactive Web Site
The Centers for Medicare and Medicaid Services (CMS) is currently working with states to design and implement new models for integrating the benefits and financing of both programs. As states build these new models, advocates for dual eligibles must be involved. This website is designed as a resource for advocates, providing resources, background information and, most importantly, in the Advocate Tools section, concrete recommendations that advocates need to engage constructively with their states to ensure that new models improve care for dual eligibles.

Improving the Qualified Medicare Benefit Program for Dual Eligibles
Source: NSCL
Content Type: PDF
Recommendations for improving QMB for beneficiaries with both Medicare and Medicaid.

Building an Integrated Appeals Process for Dual Eligibles
Source: NSCL
Content Type: PDF
This paper provides recommendations for building an integrated appeals process for individuals that qualify for Medicare and Medicaid.

Medicare and Medicaid Alignment: Challenges and Opportunities for Serving Dual Eligibles
Source: NSCLC
Content Type: PDF
Briefing paper on dual eligables.

Challenges in appeals for dual eligables
Source: NSCLC
Content Type: web page
A new issue brief from the National Senior Citizens Law Center entitled "Building an Integrated Appeals System for Dual Eligibles," recommends that as the Centers for Medicare and Medicaid Services (CMS) works with states to create new models that better integrate the delivery of Medicare and Medicaid benefits, efforts should be made to integrate the appeals processes as well. Medicare and Medicaid each have their own appeals processes with distinct rules and protections related to when someone needs to file an appeal, how many levels of appeal there are, who does the review, who makes the decisions and more.

Medicare

Key Characteristics of Medicare Beneficiaries
Source: SCAN Foundation
Content Type: PDF files
The SCAN Foundation has published a series of reports describing selected characteristics of Medicare beneficiaries Differences in Service Utilization
Residence Setting by Level of Disability
Differences in Medicare Spending by Disability and Residence
Differences in Service Utilization
Differences in Hospitalization Rates by Residents

Medicare Publications Orders
Source: CMS
Content Type: Web site
This site contains a searchable database of all CMS Medicare consumer publications.

Medicare Advantage

Medicare Part D

CBO report on Medicare Part D
Source: CBO
Content Type: PDF
A detailed reports on benefits and spending for Medicare Part D.

Medicare Part D: Materials for Advocates: Exceptions and Appeals a Practical Guide
Source: National Senior Citizens Law Center
Content Type: Manual
Practical Guide for low income advocates about Medicare Part D.

NSCLC Medicare Part D Resources
Source: National Senior Citizens Law Center
Content Type: Website
Updates for advocates on Medicare Part D as well as several reports on Medicare Part D.

"Please Hold", Medicare Plans Leave LEP Beneficiaries Waiting for Access, 2008
Source: National Senior Citizens Law Center
Content Type: Research Report
This new report from members of the California Medicare Part D Language Access Coalition shows that plans are not meeting their obligation to serve LEP clients.

Musical Chairs: An Analysis of the Part D Annual Reassignment Process
Source: National Senior Citizens Law Center
Content Type: Research Report
National overview and state specific information about Medicare Part D plan changes for 2009 and the impact of those changes on low income Medicare beneficiaries.

Medicaid

Pickle Eligibility for Medicaid
Source: NSCLC
Content Type: PDF
SSI recipients, who would otherwise be ineligible to Medicaid due to a cost of living increase, retain eligibility under the Pickle amendment. This link describes the eligibility criteria.

Across the States 2009: Profiles of Long-Term Care and Independent Living
Source: Detailed AARP report on long term care and independent living programs.
Content Type: Website

NSCLC Issue Brief on Medicaid Payment for Assisted Living
Source: National Senior Citizens Law Center
Content Type: Issue Brief
A review and exploration of issues in Medicaid payment for care in assisted living facilities for seniors and adults with disabilities.

NSCLC Medicaid Resources
Source: National Senior Citizens Law Center
Content Type: Website
Updates for advocates on Medicaid and links to related articles.

Money Follows the Person 101
Source: National Senior Citizens Law Center
Content Type: Article
An overview of the Money Follows the Person program, including descriptions of the driving forces behind it, the history of federal support for programs similar to it, and the primary challenges.

For More Information

More information on this topic might be found in the following areas of the Legal Issues library:
Long Term Care