The Dual Eligible Coalition


ABOUT THE COALITION

The Dual Eligible Coalition is a group of multi-sector stakeholders including beneficiary advocates, managed care plans, provider systems, and behavioral health and social support service organizations that is informed by state advisors. The Coalition was founded to develop actionable, long-term policy and programmatic solutions to improve the delivery of care and outcomes for the dual eligible population. 

The Coalition has been at work since 2017 to assess the challenges and opportunities facing the dual eligible population and the stakeholders who work with or serve them. The Coalition has developed a framework for fully integrating Medicare and Medicaid into a single program addressing medical, long-term care, behavioral, and social needs.

In conducting its work, the Coalition seeks to promote a set of principles around integration and whole-person care, including the following:

  • Supporting Beneficiaries to Live as Fully as Possible
  • Ensuring Comprehensive Integration
  • Promoting State-Federal Partnership
  • Ensuring Robust Reporting, Accountability, and Continuous Quality Improvement
  • Aligning Incentives for Value-Based Care
  • Promoting Consumer Engagement

The Coalition’s framework was developed through Coalition members' input and expertise, as well as a structured stakeholder outreach process in which Leavitt Partners facilitated more than 40 individual conversations with a wide array of diverse stakeholders across the health care community, including with policy experts, providers, advocates, associations, and foundations.

THE OPPORTUNITY TO IMPROVE CARE

There are more than 12 million dual eligible beneficiaries enrolled in both Medicare and Medicaid. This is a diverse population that includes people with multiple chronic conditions, developmental and physical disabilities, mental illness, cognitive impairments, and social needs.

Both MedPAC and MACPAC have noted concerns raised as to how the existence of separate funding streams creates barriers to coordination of care and the extent to which lack of coordination increases costs and leads to poor health outcomes. Numerous researchers, health policy experts, states, and stakeholders have expressed interest in seeing more aligned incentives and integrated care to improve health outcomes and quality of care for dual eligible beneficiaries.

THE COALITION'S VISION FOR INTEGRATED CARE

With more than 12 million dual eligible beneficiaries enrolled in both Medicare and Medicaid, the Coalition is committed to working collaboratively to legislatively advance its framework for fully integrating Medicare and Medicaid into a single program addressing medical, long-term care, behavioral, and social needs. The Coalition’s aim is to develop and advance federal legislation which would create a new integrated program for full benefit dual eligible beneficiaries, that states could adopt that eliminates the need to navigate both Titles 18 and 19 of the Social Security Act (SSA). The program would be overseen by CMS with robust oversight and administered by states, folding together current Medicare and Medicaid authorities and funding, into a new program under the Social Security Act.


OUR MEMBERS

  • Centene
  • Commonwealth Care Alliance
  • Community Catalyst
  • Health Plan of San Mateo
  • Independent Living Systems
  • Justice in Aging
  • Kaiser Permanente
  • L.A. Care Health Plan
  • Medicare Rights Center
  • Molina
  • National Alliance on Mental Illness
  • UPMC (University of Pittsburgh Medical Center)