Medicare Rights Center

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

These patients experience higher levels of chronic illness and are more likely to be disabled. Despite the complex needs of dual-eligible patients, their care tends to be fragmented and uncoordinated. Integrated care will result in simpler enrollment processes, greater continuity of care, improved coverage, integrated appeals, and administrative efficiencies, but operationalizing it has proven difficult. Currently, only 4% of dual-eligible patients in New York State receive fully integrated care, but the New York State Department of Health (NYSDOH) recently announced plans to increase enrollment in fully integrated care by 250% by the end of 2023. As New York State embarks on this effort, it is imperative that the needs of beneficiaries are at the forefront. In 2022, NYHealth awarded Medicare Rights Center (MRC) a grant to advocate for and educate decision-makers about implementation of the State’s integrated care plans.

Under this grant, MRC and its Coalition to Protect the Rights of New York’s Dually Eligible advocated for consumer-oriented solutions. It shaped new integrated care health plan products, addressing issues with provider networks; requirements about consumer-friendliness and language access; and protocols to ensure continuity of care and patient choice. It safeguarded the integrated appeals process for patients as well as improved upon existing educational materials and content so they are culturally and linguistically appropriate and accessible for dual-eligible patients. MRC also leveraged its established relationships to advocate for consumers and issued a policy report on the State’s integrated care landscape, including recommendations drawn from dual-eligible patients’ stories. Finally, MRC developed and disseminated a toolkit to help the State’s dual-eligible patients and their care providers understand and navigate integrated care. MRC disseminated the toolkit via multiple channels, including through its helpline for dual-eligible patients, its broad-reaching newsletter, and statewide webinars.