Provider network protections in D-SNP State Medicaid Agency Contracts are essential to ensure continuity of care, maintain access to trusted providers, and prevent disruptions for dually eligible individuals navigating Medicare and Medicaid coverage.
States can help people keep their Medicaid coverage by reducing paperwork and allowing self-reporting of health conditions and caregiving responsibilities as work requirement exemptions. These steps prevent unnecessary coverage loss and help eligible people stay enrolled and access needed care.
States can help people keep their Medicaid coverage by reducing paperwork and allowing them to self-report health conditions and caregiving responsibilities as exemptions from work requirements.
This toolkit outlines consumer protections and member rights in D-SNP State Medicaid Agency Contracts, emphasizing continuity of care, accessible appeals processes, and strong safeguards to ensure dually eligible individuals maintain coverage and access to essential services.
This toolkit highlights best practices for member engagement and support in D-SNP State Medicaid Agency Contracts, emphasizing enrollee advisory committees, ombuds programs, and meaningful consumer input to improve access, equity, and quality of care for dually eligible individuals.
Care coordination for people dually eligible is shaped by several overarching federal requirements, including Model of Care requirements, the Home and Community-Based Settings Rule, and the Medicaid Access Rule.
People dually eligible often experience significant confusion during the D-SNP enrollment process, especially regarding the eligibility criteria for enrolling in a D-SNP, whether they may be subject to default enrollment, and what protections are available if they lose D-SNP eligibility.
People are often overwhelmed by the confusing notices they receive about their Medicare and Medicaid coverage. This toolkit helps advocates develop State Medicaid Agency Contract (SMAC) language that requires managed care plans to provide accessible communications for their enrollees.
With support from the California Department of Aging, Justice in Aging is providing targeted resources and trainings, technical assistance, opportunities to connect, and capacity building support to California legal services providers to help them meet the needs of the state’s low-income older adults.
