New Medicare Rights Center Case Study Series Highlights Experiences of Dually Eligible Individuals

This week, Medicare Rights released a new case study series to inform conversations and policy decisions around enhancing benefits access and coordination for individuals who are dually eligible for Medicare and Medicaid.

Every year on our national helpline, Medicare Rights hears from Medicare-Medicaid enrollees, their families, and caregivers, as well as enrollment and coverage assistors with questions about how to navigate the Medicare and Medicaid systems. The case studies draw directly from this work. They provide an important look at the challenges facing people who are dually eligible and offer valuable insights into how better collaboration between Medicare and Medicaid could significantly improve access to affordable, comprehensive, high-quality health care.

The case studies highlight the following real-life scenarios from our national helpline:

• Medicare Savings Program Enrollment: This case study focuses on how automatic enrollment in Medicare Savings Programs (MSPs) can remove many individuals’ barriers when enrolling. Separately, an interactive case study on MSP enrollment immerses users, allowing them to experience the frustrations and roadblocks from our client’s perspective. Simplifying the enrollment process is essential to increasing participation and ensuring that more people can benefit from these vital programs.
• Medicare Savings Program Recertification: Medicare Savings Program recertification varies widely nationwide. This case study compares two experiences—one with automatic recertification and one with a more complex process—to illustrate the need for nationwide Medicare Savings Program recertification improvements.
• Medicaid Renewal: Renewing Aged, Blind, and Disabled Medicaid is necessary to maintain benefits. This case study contrasts a complicated renewal process with one eased by COVID-19 public health emergency flexibilities, arguing for lasting reforms in Medicaid renewal procedures.
• Medicare-Medicaid Integration: Coordinating benefits and services for dually eligible individuals is often complex and disjointed. This case study examines the challenges of poorly integrated care and offers recommendations for improving integration at both state and federal levels.

By following the experiences of our dually eligible clients and their helpline counselors, the series reveals the complexities and opportunities inherent in the coordination between Medicare and Medicaid and highlights how even simple changes can lead to substantial improvements in accessing benefits and care. Critically, these experiences also form the basis of Medicare Rights’ policy recommendations, which aim to make Medicare, Medicaid, and MSPs more accessible, user-friendly, and sustainable for all beneficiaries.

We invite policymakers, Medicare beneficiaries, advocates, and other stakeholders to explore these resources and join our efforts to improve benefits access and coordination for dually eligible individuals. Together, we can create a more equitable and efficient system for all.

Access the case study series here.

The series also includes an explainer video that provides context and explains the terminology, systems, and challenges associated with Medicare, Medicaid, and MSPs. It is an ideal starting point for those new to these issues.