Projects

Experience of Health Care and Other Services for Individuals Dually Eligible for Medicare and Medicaid

2021-2026

Project Overview

Objective

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.

Project Motivation

The 12.4 million dually eligible individuals are an increasingly diverse population with significant health care and social needs that disproportionately account for costs in both the Medicare and Medicaid programs. Understanding their experiences is crucial to improving enrollment in integrated care, policies related to dually eligible individuals, and their health and other outcomes.

Partners in Progress

Community Catalyst and the National Association of State Directors of Developmental Disabilities Services (NASDDDS).

Prepared For

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Medicare - Medicaid Coordination Office

Through enrollee interviews, Mathematica is uncovering how Medicare and Medicaid integration works on the ground level, and what can be done to improve the lives for dually eligible individuals. 

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 enrollees participating in the Financial Alignment Initiative (FAI) demonstrations and Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs).

Mathematica leads qualitative research studies through enrollee 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 communication 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 in integrated care plans. Final reports and summary documents describe the methodology, respondents’ characteristics, findings, and resulting recommendations from each study. 

Related Staff

Danielle Chelminsky

Danielle Chelminsky

Senior Researcher

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Rachel Kogan

Rachel Kogan

Senior Survey Researcher

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Danielle Whicher

Danielle Whicher

Researcher

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Victoria Peebles

Victoria Peebles

Researcher

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Olivia Chan

Olivia Chan

Research Analyst

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Debra  Lipson

Debra Lipson

Senior Fellow

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Erin Weir Lakhmani

Erin Weir Lakhmani

Principal Researcher

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