Dual Eligible Demonstrations: The Beneficiary Perspective

Beneficiary Profiles

Desiree, age 28, Massachusetts
Desiree lives independently and uses a power wheelchair, a service dog, and personal care services for help with activities of daily living as a result of a genetic condition. She is happy with the demonstration now that she has an assigned care coordinator but found the program very difficult to navigate initially, leading to a delay in a needed wheelchair service authorization. She believes that the demonstration could be improved to better meet the needs of people like her who work full-time.

Rob, age 65, Ohio
Rob, who has multiple chronic conditions, likes the concept of the demonstration, but has had initial difficulties with the enrollment process and getting updated information about participating providers. After initial delays in having someone assigned, he is now in regular contact with his care coordinator but has not yet received a needs assessment to begin the care planning process.

Eric, age 31, Virginia
Eric attends community college and receives regular intensive outpatient behavioral health services. He was surprised to be enrolled in the demonstration but is generally satisfied, particularly with the new dental benefit. He has only had one call from his health plan, however, and does not know who to contact with questions, such as where he should go in a psychiatric emergency.

Mary Francis, age 88, Virginia
Following a stroke, Mary Francis has difficulty walking and is prone to falls. She has multiple chronic conditions and attends an adult day health center. Mary Francis is very pleased with her care coordinator’s review of her medications, help with arranging rehabilitation services, and accompanying her to a doctor’s visit. However, she recently was disenrolled from the demonstration, due to a mix-up with her Medicaid renewal paperwork, and is in the process of re-enrolling with the health plan.

John, age 41, Ohio
John has quadriplegia and worried that enrolling in a health plan would disrupt his existing arrangements with the home health aides on whom he relies to help him get ready each morning. He was unable to find a health plan whose network included all of his longstanding providers, although he thinks that the plan provider networks are growing. He also experienced a delayed authorization to replace the battery in his ceiling lift, as a result of late plan payments to the vendor, placing him at risk of injury when transferring from his power wheelchair. He is interested in possibly self-directing his services once that option is fully implemented.

Sylvia, age 44, Massachusetts
Anxiety and depression made it difficult for Sylvia to make and keep physical therapy appointments following back and shoulder surgery and to arrange care for other conditions. Living alone and feeling isolated at times, she enrolled in the demonstration because she would welcome help with care coordination. Her regular doctor was able to become a participating network provider without any disruption in her care, but Sylvia does not know how to initiate the care planning process with her health plan.