With the new Medicare prescription drug benefit available as of January 1, 2006, over 6 million low-income seniors and people with disabilities who are enrolled in both Medicaid and Medicare—also known as dual eligibles—have been transitioned from Medicaid drug coverage to new Medicare drug plans. While there are many policy issues related to the overall establishment of the new drug benefit, the mandatory transition of dual eligibles has created a special set of challenges for the federal government, states, and beneficiaries.

If the characteristics of dual eligibles are examined, it becomes evident that they will need special attention when being enrolled in the new Medicare benefit:

• Nearly three-quarters (73%) have $10,000 or less in income
• 61 percent have less than a high school education
• More than one-third (37%) are disabled
• More than one-third (34%) have a mental impairment
• More than one-quarter (27%) have diabetes
• Nearly one-fifth (19%) reside in a long-term care facility

A collection of information and publications on dual eligibles, their current drug coverage, and issues related to their transition to the new Medicare benefit follows:

Who are the Dual Eligibles?

Dual Eligibles: Medicaid’s Role for Low-Income Medicare Beneficiaries

Profiles of Medicare Beneficiaries With Medicaid Drug Coverage Prior to the Medicare Drug Benefit (.pdf)

Dual Eligibles: Medicaid Enrollment and Spending for Medicare Beneficiaries in 2003

The Stability of Medicaid Coverage for Low-Income Dually Eligible Medicare Beneficiaries

The Transition to Part D

The Transition of Dual Eligibles to Medicare Part D Prescription Drug Coverage: State Actions During Implementation

Dual Eligibles and Medicare Part D: An Implementation Update

Medicare Beneficiaries with Prescription Drug Coverage by Type, as of January 13, 2006

Distribution of Medicare Beneficiaries with Prescription Drug Coverage by Type, as of January 13, 2006

An Implementation Perspective on Part D, the Medicare Prescription Drug Program

Podcast: Insights on Transitioning From Medicaid to the New Medicare Prescription Drug Benefit: Audio Briefing (Downloadable Audio File)
Speakers include: Barbara Lyons, Deputy Director, Kaiser Commission on Medicaid and the Uninsured, Linda Elam, Senior Associate, KCMU; Vern Smith, Principal, Health Management Associates; Michael Perry, Partner, Lake Research Partners; and Michael McMullan, Deputy Director for Beneficiary Services, Center for Beneficiary Choices, Centers for Medicare & Medicaid Services.

Please note: the audio is no longer available.  If you have an urgent need for the audio, you may contact us (choose “problem with video” on the form) and we will try to locate it.  Include the URL for this page in your message to us.

For KFF reference: /podcast/dualsrx.mp3

Medicare Prescription Drug Coverage for Residents of Nursing Homes and Assisted Living Facilities: Special Problems and Concerns

Prescription Drug Coverage under Medicaid

State Medicaid Outpatient Prescription Drug Policies: Findings from a National Survey, 2005 Update

Medicaid and Outpatient Prescription Drugs

The Clawback

An Update on the Clawback: Revised Health Spending Data Change State Financial Obligations for the New Medicare Drug Benefit

The “Clawback”: State Financing of Medicare Drug Coverage

Other Resources

Overview of the Many Steps that CMS has taken to Make Sure All Dual Eligibles have Medicare Prescription Drug Coverage January 1, 2006
.pdf on CMS Website

Medicare: Contingency Plans to Address Potential Problems with the Transition of Dual-Eligible Beneficiaries from Medicaid to Medicare Drug Coverage
.pdf on GAO Website