Mathematica Policy Research, Inc.

Individuals who qualify for both Medicare and Medicaid, known as “dual eligibles,” are among New York State’s costliest and most complex Medicaid beneficiaries.

Because they have greater care needs than the average Medicaid enrollee, dual eligibles often require a complex array of services from multiple providers. Managed care organizations have limited experience in serving this population and dual eligibles themselves are concerned about potential restrictions to provider access under managed care. However, recent developments at both the Federal and State levels are providing new opportunities to better coordinate care for this costly and complex population. To capitalize on this new momentum, Mathematica Policy Research, Inc. (MPR) provided technical assistance to New York State to design a program that better integrates Medicare and Medicaid services, improves care, and reduces unnecessary spending for the dual eligibles.

Specifically, MPR:

• Conducted structured interviews with State Medicaid officials, payers, health care providers, long-term care providers, and patient representatives to discuss dual eligible integration programs implemented or being developed in other states;
• Created a comprehensive profile of the benefits that dual eligibles are accessing through Medicare, Medicaid, and associated spending, identifying any duplication in services provided by the programs, and highlighted areas where more coordination is needed; and
• Outlined integrated care program design options based on its review of programs in other states, the characteristics and care needs of dual eligibles in New York State, and options that appear feasible in light of current State capabilities and potential for Federal approval.

Read the report associated with this grant, “Integrating Care for Dual Eligibles in New York: Issues and Options.”