Dual Eligibles

Advocate’s Guide on California’s Coordinated Care Initiative

By | Alerts, CA Health Network Alert, DUAL ELIGIBLES, REPORTS | No Comments

July 2013 — The Advocate’s Guide to California’s Coordinated Care Initiative helps advocates understand the Coordinated Care Initiative (CCI), a new state program changing the way dual eligible beneficiaries and other seniors and persons with disabilities get their health care in eight California counties.

The guide includes a description of the CCI, information on whom the CCI impacts, how individual beneficiaries are impacted, why it is being implemented and when and where the program is taking place.

The guide, which will be updated as program rules develop and change, includes a pull-out table that an advocate can use to determine who the CCI impacts and how it affects beneficiaries.

The National Senior Citizens Law Center and the Disability Rights Education and Defense Fund (DREDF) coauthored the guide.

QMB Program Needs Fixes to Operate Effectively

By | DUAL ELIGIBLES, REPORTS | No Comments

(11/16/11) A new issue brief from NSCLC says that dual eligibles who qualify for the Qualified Medicare Beneficiary (QMB) program often go without needed care because they can’t find physician specialists, mental health professionals or other providers who are willing to serve them and may end up facing demands from providers for co-payments that they should not have to pay.

To read a press release about the brief, click here.

Appeals Processes Need to be Integrated for Dual Eligibles

By | DUAL ELIGIBLES, REPORTS | No Comments

(10/4/11) An 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.

To read a press release about the brief, click here.

To listen to and see the power point from the webinar, click here.

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