Dual
Eligibles

Integrating Care Through Medicare & Medicaid

There are 10.8 million individuals enrolled in both Medicare and Medicaid across the country. All are low-income and most have high health care needs and face barriers in accessing the care they need. Explore the sections below to find Issue Briefs, Fact Sheets, and other resources to help you connect older adults to these programs, as well as advocacy tips and manuals to help you expand, improve, and protect the programs in your own community. If you’re looking for a specific resource you don’t see here, or would like to explore older resources, search our Resource Library

  • Improper Billing Tookit
  • Written Resources
  • Trainings
  • Model Letters
  • CMS Documents
  • Consumer Resources

Improper billing (also sometimes referred to as “balance billing”) occurs when doctors, hospitals, or other providers charge beneficiaries with both Medicaid and Medicare for co-pays, co-insurance, or deductibles.

Patients who have both Medicaid and Medicare (including Medicare Advantage) should never be charged for services covered under Medicaid or Medicare. Billing for covered services is illegal under both federal and state law.

  • National Dual Eligible Advocacy
  • Fact Sheets & FAQs
  • Issue Briefs

The resources in this section reflect the various issues dual eligibles face in accessing and being able to afford health care. From improper billing to helping older immigrants access health care, advocates will find resources to solve those and other issues.

  • California Dual Eligible Demonstration & System Reform
  • CCI Advocates Guide
  • CCI Fix Lists
  • Fact Sheets & Issue Briefs
  • Webinars
  • Comments on New Duals Enrollment Proposal 2016
  • Evaluations

As home to 1.4 million low-income older adults who are eligible for both Medicare and Medicaid (more than any other state), California has been a test case for a massive effort to coordinate their care. Throughout the roll-out of the state's Coordinated Care Initiative (CCI), beginning in 2014, Justice in Aging has trained thousands of advocates on the changes, heard from them about issues in the roll-out, and pushed the state for fixes. We also share our knowledge with advocates in other states to help them as their states roll out similar programs.

How is the CCI Working? An Advocate Fact Sheet on evaluations of the CCI

Results:

Evaluation of Cal MediConnect – Focus Group Results

Evaluation of Cal MediConnect – Telephone Survey Results

Rapid Cycle Polling Project October 2015 | December 2015

An earlier RTI evaluation focusing on implementation of demonstrations in California, Illinois, Massachusetts, Ohio, Virginia, and Washington can be found here.

  • National Dual Eligible Demonstration Toolkit
  • Appeals
  • Outreach & Notices
  • Continuity of Care & Consumer Protections
  • Evaluations
  • Medicare Savings Programs

Under the Affordable Care Act Centers for Medicare and Medicaid Services (CMS) created a new office to focus exclusively on individuals who qualify for Medicare and Medicaid, dual eligibles. The new entity, the Medicare-Medicaid Coordination Office, began working with states across the country to better align Medicare and Medicaid benefits through state-run dual eligible demonstrations. Justice in Aging ensures dual eligibles entering these new programs are adequately informed of care changes; retain access to doctors of their choice; maintain services and care without disruptions; and get help navigating an appeals system that honors their due process rights.