Dual Eligible Demonstrations: The Beneficiary Perspective

The financial alignment demonstrations for seniors and younger people with disabilities dually eligible for Medicare and Medicaid are joint efforts of selected states and the Centers for Medicare and Medicaid Services (CMS), designed to align benefits and financing with the goals of delivering better coordinated care and reducing costs. These three-year demonstrations are based on authority in the Affordable Care Act and were implemented beginning in July 2013.

Recent case studies describe program design and early implementation activities in three of the first states to enroll dually eligible beneficiaries in these demonstrations: Massachusetts, Ohio, and Virginia. This issue brief provides additional information and insights about initial program activities from the perspective of beneficiaries in these three states, based on 12 individual interviews conducted in early 2015. Profiles of six beneficiaries are presented to illustrate representative program experiences, along with key findings from across all of the interviews.

Interviewees include seniors and younger people with a range of physical and mental health disabilities and chronic conditions. All live independently in the community. Some voluntarily enrolled in the demonstration, and others were automatically enrolled. They were asked to comment on how they initially heard about the demonstration, their experience with the enrollment process, whether they had help or advice when they enrolled, the needs assessment process associated with the demonstration, their access to medical and other services, their experience with care coordination, if they know who to contact should problems arise, and whether they have suggestions for improving the program.