Strengthening the Enrollment Assistance Infrastructure for Dually Eligible Individuals

The COVID-19 pandemic has elevated how critical health coverage is for dually eligible individuals – the over 12 million individuals with disabilities and older adults with low incomes who are enrolled in both Medicaid and Medicare. Unfortunately, COVID-19 has had a significantly disparate impact on this population, who became sick and/or hospitalized from the virus at higher rates than individuals enrolled in Medicare only. Additionally, as the result of the negative health effects of long-standing structural racism, Black and Indigenous dually eligible individuals were hospitalized with COVID-19 at almost three times the rate of their white counterparts.

Not only has the pandemic been more difficult for this population, but their path to gaining health coverage is also more complex than for individuals who are eligible for only one type of health coverage, since they must first enroll in both Medicaid and Medicare separately, and then can choose from a range of integrated care plan options. Such plans receive payments from Medicaid and Medicare to coordinate and administer the benefits of both programs. Although integrated care plans have the potential to provide more coordinated and comprehensive care, enrollment in these plans has remained surprisingly low.

Given the status of enrollment in integrated care, Community Catalyst and the Institute for Community Health conducted research to better understand the perspectives of dually eligible individuals when it comes to enrolling in integrated care. We conducted focus groups and interviews to better understand their enrollment experience as well as to learn what’s most important to them about integrated care. Our conversations revealed several important factors, including the ability to receive sufficient information for them to make an informed decision, as well as the opportunity to speak with a knowledgeable, trustworthy expert about their integrated care options.

Unfortunately, the current enrollment assistance infrastructure doesn’t provide dually eligible individuals with a centralized place where they can learn about their integrated care options. There are currently tools available in some states that help individuals learn about and compare integrated care options, such as MyCareMyChoice.org, and there are also programs like the State Health Insurance Assistance Program (SHIP), ombudsman programs and others that can help individuals learn about integrated care. However, these types of resources and services aren’t uniformly available to all dually eligible individuals in all states. Therefore, our enrollment report recommends the federal government create an integrated care “resource hub” to provide clear, comprehensive information and allow individuals to speak with a trained expert, or “enrollment assister.” The report also recommends ensuring information is provided in ways that are culturally competent, respectful and inclusive, such as in primary languages other than English and alternative text formats, as well as requiring enrollment assisters to undergo sufficient training to provide information in these ways. While federal and state policymakers as well as integrated care plans are certainly taking steps in the right direction, our toolkit provides additional recommendations and best practices that will ultimately help improve integrated care enrollment, as well as the care experience overall.

The COVID-19 pandemic brought a new sense of urgency to the unmet needs of dually eligible individuals, given that they, and in particular dually eligible people of color, were disproportionately impacted by COVID-19 infection, hospitalization, complications and death. While integrated care can allow dually eligible individuals to have more coordinated health coverage and benefits, more outreach and education needs to be done so that this population can be made more aware of integrated care and how it may benefit them. Our research elevated a key gap in the current integrated care enrollment ecosystem: a lack of comprehensive, inclusive and unbiased information on integrated care options. We hope our recommendations and best practices help empower dually eligible individuals to enroll the right health coverage option for them.