advancing the policy environment to address the unique needs of partial dual eligible beneficiaries
While recent policy attention and innovation has been directed at “dual eligible” beneficiaries who qualify for both Medicare and Medicaid, little attention has been given to partial dual eligibles (Medicare beneficiaries who receive limited financial support from their state Medicaid program to cover Medicare out-of-pocket costs, but do not otherwise receive Medicaid benefits). Policymaking that centers around integration between Medicare and Medicaid has largely ignored partial duals, resulting in significant gaps for this population. Moreover, the lack of research and policymaking on this population has led to poor understanding of the unique and complex needs experienced by partial duals.
Supported by the Anthem Public Policy Institute, ATI Advisory analyzed data from the 2018 Medicare Current Beneficiary Survey (MCBS) and the 2018-2020 Master Beneficiary Summary File (MBSF) to quantify the needs and experiences of the partial dual eligible population, compared with the full dual eligible population and Medicare-only beneficiaries. Our findings demonstrate that partial dual beneficiaries are a high-need subset of the Medicare population, in many instances mirroring the full dual population in their level of medical and functional needs. We also identified that a sizeable portion of partial dual beneficiaries experience volatility in their Medicaid eligibility, including gaining (and retaining) full dual eligibility over time.
Integration is a critically important goal regarding dual eligible beneficiaries, however, focusing exclusively on integration rather than the broader complexity of dual beneficiaries has negatively impacted partial duals. Much of the policy conversation has ignored this population, and some policy recommendations explicitly exclude partial dual beneficiaries from dual eligible programs. Our work illuminates the profile of partial dual beneficiaries and their resemblance to the full dual population. Based on this research, ATI Advisory has identified a set of recommendations for policymakers to consider to ensure partial dual beneficiaries have access to appropriately designed programs and products that address their complex needs.