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Opportunities for Integration in the Dual Medicare-Medicaid Population: North Carolina Landscape Analysis

Publication ,  Journal Article
Freed, SS; Frascino, N; Jones, KA; Giri, A; Stewart, L; Hendel, K; Clark, AG; Van Houtven, C; Higgins, A; Kaufman, BG
Published in: North Carolina Medical Journal
January 1, 2024

BACKGROUND NC Medicaid is amid a transformation to value-based care models. The transformation requires the consideration of models that may best serve the 1 in 5 NC Medicaid beneficiaries who are dually enrolled in Medicare. The lack of integration of Medicare and Medicaid administration, financing, and care may contribute to suboptimal health outcomes and care experiences. Integrating Medicare and Medicaid to improve care for dually enrolled individuals requires knowledge of the demographic, eligibility, and enrollment trends, as well as the medical needs of these individuals throughout North Carolina. METHODS We performed a cross-sectional analysis of 2019 NC Medicaid administrative enrollment data and 2015–2020 Medicare and Medicaid public use files. RESULTS Nearly half of North Carolina’s full-benefit dual-eligible (FBDE) population was eligible for Medicare due to disability. About one-third of the FBDE population lost full Medicaid benefits at some point during 2019; of these, 65% were under age 65. Most FBDE beneficiaries were enrolled in Medicaid fee-for-service, with 3.5% enrolled in Community Alternatives Program (CAP) waivers, 2% in Medicaid waivers for beneficiaries with behavioral health or intellectual and developmental disabilities (BH/IDD) or traumatic brain injury (TBI), and 1% in the Program of All-Inclusive Care for the Elderly (PACE). Enrollment in Medicare Duals Special Needs Plans (D-SNPs) increased from 7.3% of the FBDE population in 2015 to 32.5% in 2021. LIMITATIONS This descriptive, cross-sectional evaluation of North Carolina duals may not be generalizable to other time periods and con-texts. CONCLUSION Medicare-Medicaid integration presents an opportunity to improve the value of care for dual-eligible beneficiaries and aligns with the goals of NC Medicaid transformation. Integration strategies that leverage the current infrastructure may minimize disruption of services for beneficiaries and mitigate the impacts of unstable enrollment, particularly among working-age adults and disabled beneficia-ries. The diversity within the dual-eligible populations requires a strategy designed to improve health equity across race, disability, eligibil-ity, geography, and health care needs.

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Published In

North Carolina Medical Journal

DOI

ISSN

0029-2559

Publication Date

January 1, 2024

Volume

85

Issue

2

Start / End Page

150 / 158

Related Subject Headings

  • 42 Health sciences
  • 32 Biomedical and clinical sciences
  • 11 Medical and Health Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Freed, S. S., Frascino, N., Jones, K. A., Giri, A., Stewart, L., Hendel, K., … Kaufman, B. G. (2024). Opportunities for Integration in the Dual Medicare-Medicaid Population: North Carolina Landscape Analysis. North Carolina Medical Journal, 85(2), 150–158. https://doi.org/10.18043/001c.94879
Freed, S. S., N. Frascino, K. A. Jones, A. Giri, L. Stewart, K. Hendel, A. G. Clark, C. Van Houtven, A. Higgins, and B. G. Kaufman. “Opportunities for Integration in the Dual Medicare-Medicaid Population: North Carolina Landscape Analysis.” North Carolina Medical Journal 85, no. 2 (January 1, 2024): 150–58. https://doi.org/10.18043/001c.94879.
Freed SS, Frascino N, Jones KA, Giri A, Stewart L, Hendel K, et al. Opportunities for Integration in the Dual Medicare-Medicaid Population: North Carolina Landscape Analysis. North Carolina Medical Journal. 2024 Jan 1;85(2):150–8.
Freed, S. S., et al. “Opportunities for Integration in the Dual Medicare-Medicaid Population: North Carolina Landscape Analysis.” North Carolina Medical Journal, vol. 85, no. 2, Jan. 2024, pp. 150–58. Scopus, doi:10.18043/001c.94879.
Freed SS, Frascino N, Jones KA, Giri A, Stewart L, Hendel K, Clark AG, Van Houtven C, Higgins A, Kaufman BG. Opportunities for Integration in the Dual Medicare-Medicaid Population: North Carolina Landscape Analysis. North Carolina Medical Journal. 2024 Jan 1;85(2):150–158.

Published In

North Carolina Medical Journal

DOI

ISSN

0029-2559

Publication Date

January 1, 2024

Volume

85

Issue

2

Start / End Page

150 / 158

Related Subject Headings

  • 42 Health sciences
  • 32 Biomedical and clinical sciences
  • 11 Medical and Health Sciences