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.
Starting in January 2025, two new Medicare Special Enrollment Periods (SEPs) will impact when low-income individuals can join, switch, or leave Medicare Advantage Plans or Prescription Drug Plans.
This blog presents guiding principles for developing and implementing integrated models for individuals dually eligible for Medicare and Medicaid. The principles underscore the fundamental values and goals that should inform the design of integrated models, including robust consumer protections, health equity, person-centered care, and vigorous oversight and accountability.
This brief provides advocates with basic information about Dual Eligible Special Needs Plans (D-SNPs) and how they can improve service coordination for dual-eligible populations.
