A Primer on the Dual Eligible Population in Massachusetts

Prepared with the Blue Cross Blue Shield of Massachusetts Foundation

Across the United States, over 12 million low-income seniors and individuals with disabilities receive health care coverage through both their state Medicaid program and Medicare; these are known as dual eligible individuals. Dual eligible individuals often have some of the most complex care needs. Many require not only physical and behavioral health care, but also long-term services and supports (LTSS) such as home health aide and personal care services to help them with their daily care needs and routines.

Of the more than 1.8 million people enrolled in MassHealth, Massachusetts’ Medicaid program, one in five are dually eligible and receive health care coverage through two distinct payers: Medicare and MassHealth. Massachusetts has long recognized the challenges in coordinating care for this population with complex needs, and the state has been a pioneer in implementing integrated care programs that cover these members’ comprehensive Medicare and MassHealth benefits through a single program administered by MassHealth.

In “A Primer on the Dual Eligible Population in Massachusetts,” developed with the Blue Cross Blue Shield of Massachusetts Foundation, Manatt Health senior advisor Stephanie Anthony, director Kevin Casey McAvey and senior manager Jacqueline D. Marks illustrate the diversity of dual eligible individuals’ clinical and functional needs, service utilization, and spending patterns. The primer also describes the program options that are available to meet their needs, with a particular focus on MassHealth’s integrated care programs: One Care, the Program of All-Inclusive Care for the Elderly (PACE) and Senior Care Options (SCO). Also included in the primer is a description of the state’s proposed reforms, known as the Duals Demonstration 2.0, to increase enrollment in One Care and SCO and to improve care integration and quality for dual eligible members. The primer consists of an issue brief on dual eligible care in Massachusetts, a comparative assessment of the state’s existing integrated care programs, a data chart pack analyzing trends among dual eligible individuals, and a set of five profiles of dual eligible members enrolled in integrated care and fee-for-service delivery systems in Massachusetts.

To access the issue brief, click here.

To access the comparative assessment, click here.

To access the data chart pack, click here.

To access the member profiles, click here.

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