Understanding the Experiences of Dually Eligible Beneficiaries Enrolled in One Care
Research Regarding the Experience of Health Care and Other Services for Individuals Dually Eligible for Medicare and Medicaid
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Medicare - Medicaid Coordination Office
- Most interviewees reported satisfaction with the access and quality of their medical care through their Medicare-Medicaid Plans (MMPs), and most used their MMPs to access the Durable Medical Equipment (DME) and home- and community-based services (HCBS), needed to manage their health.
- Interviewees generally shared positive feedback about working with health teams, especially how providers, coordinators and informal supports communicated with one another to facilitate their care. Those with a recent in-patient hospitalization were satisfied with the after-care experiences facilitated by their MMP.
- Despite reporting highly positive MMP experiences overall, interviewees who spoke only Spanish reported less communication, care coordination, HCBS and Non-Emergency Medical Transportation (NEMT) use than that reported by English-speaking participants.
- Interviewees who were blind or had low vision reported more difficulty reaching their MMP and receiving educational materials on member protections than those who were not blind or had low vision. A few commented that their MMP’s automated phone system and mailed materials were inaccessible.
- Many interviewees reported housing as an unmet social need, especially citing affordability and neighborhood safety concerns. Though a few reportedly accessed community resources such as COVID-19 rental forgiveness funds or Section 8 housing vouchers, only a few reportedly discussed their housing needs with their care coordinator. Most who did ask their care coordinator for help securing affordable and safe housing said they did not receive the help they sought.
One Care was designed to serve a complex population, many with Long-Term Services and Supports (LTSS) and behavioral health (BH) needs. The research results of this study are based on interviews conducted with One Care members dually eligible for Medicare and full Medicaid benefits. Our research explored beneficiary experiences with 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. This research was designed in collaboration with the Centers for Medicare & Medicaid Services (CMS) and Massachusetts and was informed in part by the state’s Care Model Focus Initiative (CMFI), which aimed to identify action steps to ensure that the demonstration is implemented as intended.