Project Overview
To help the Centers for Medicare & Medicaid Services (CMS) and state Medicaid agencies and partners understand how dually eligible individuals experience the Medicare and Medicaid programs and care systems and identify policies and strategies to improve how programs work for this population and the quality of care they receive.
The 12.3 million dually eligible individuals are a highly vulnerable and increasingly diverse population with significant health care needs that disproportionately accounts for costs in both programs. Understanding their experiences is crucial to improving enrollment, policies, and outcomes.
Community Catalyst and the National Association of State Directors of Developmental Disabilities Services (NASDDDS).
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Medicare - Medicaid Coordination Office
On behalf of the Medicare-Medicaid Coordination Office (MMCO) at the Centers for Medicare & Medicaid Services (CMS) Mathematica, in collaboration with its partners at Community Catalyst and NASDDDS, is conducting a series of qualitative studies in several states each year to better understand the health care experiences of dually eligible individuals enrolled in an integrated care plan. The studies focus on beneficiaries participating in the Financial Alignment Initiative (FAI) demonstrations and Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs).
Mathematica leads qualitative research studies through beneficiary interviews focused on understanding how dually eligible individuals experience Medicare and Medicaid systems, processes, and services.
In addition, another type of study includes materials testing, which tests and refines materials used by CMS, states, plans, or providers to communicate with dually eligible individuals and their caregivers. These materials, which might range from educational materials to benefit explanations, frequently contain detailed information that help dually eligible individuals make informed choices and understand their rights, including their right to appeal coverage decisions.
Mathematica uses human-centered design strategies including journey mapping and user personas to better capture the experiences of dually eligible individuals. Final reports and summary documents describe the methodology, respondents’ characteristics, findings, and resulting recommendations from each study.
Evidence & Insights From This Project

Understanding the Experiences of Dually Eligible Beneficiaries Enrolled in One Care
This brief report describes our research on the beneficiary experience of care coordination and access to health care services, home- and community-based services (HCBS), and social services in the Medicare- Medicaid Financial Alignment Initiative (FAI) demonstration in Massachusetts.
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