Improving Access to Medicare and Medicaid Coverage: Input Summary
We’re looking at Medicare and Medicaid coverage in Wisconsin and how well they work together. The goal is to improve Dual Eligible Special Needs Plans (D-SNPs) to provide a better experience for people with disabilities and older adults. To gather input, we held one-on-one meetings, joined large group discussions, and sent surveys to:
- People who have both Medicare and Medicaid (known as dual eligible members)
- Health insurance plans
- Health care providers
- State Health Insurance Assistance Program (SHIP) counselors
Input summary
Members with both Medicare and Medicaid don't understand available coverage options.
Members in D-SNPs have trouble accessing providers and services.
Members need comprehensive care coordination to address complex care needs.
There are common barriers for plans in offering or expanding Fully Integrated SNPs, which cover long term care services from nursing homes or the equivalent in the community.
Members and SHIP and ADRC staff need more education on how Medicare and Medicaid work together.
Key feedback, directly from members and partners
The beneficiaries we serve across the state are often confused and overwhelmed by the amount of choice available in the D-SNP world.
-Medigap Helpline Services Supervisor
A lot of these [options counseling supports] don't have the capacity or understanding to handle people with complex needs. I have some very complex situations so what folks like me need is better integration and not restrictions/roadblocks to getting care we need. If a plan can provide better access/integration that would be a large-scale goal.
-Member with both Medicare and Medicaid
There’s a long history of collaboration in Minnesota between special needs plans that are offering FIDE SNP and the state Medicaid agency and how we communicate together to create information and resources. Sometimes the state will bring us together and put together information that can be shared.
-Health plan representative
Making sure whoever the trusted person for that member, whether it’s a broker or county staff, making sure that the right information is available in terms of value and benefits of D-SNP.
-Health plan representative
I have had people very happy with the ‘extra benefits,’ but I have had agents enroll people in a D-SNP and their doctors are not in the network.
-SHIP counselor/leadership
Many are enrolled into plans that don’t work with their preferred health system, or their primary care physician isn’t in network.
-SHIP counselor/leadership
Survey data
SHIP and ADRC staff weighed in on what members need most
SHIP and ADRC staff help members choose what coverage might be right for them. They shared their thoughts on what members with both Medicare and Medicaid need the most while they select Medicare coverage.
- Help understanding their Medicaid and Medicare benefits, including Medicare Advantage supplemental benefits (74%)
- Help navigating the complex set of Medicaid and Medicare coverage options available in Wisconsin (67%)
[Members need a] clearer understanding of the differences between private and public Medicare. A simpler way to be able to confirm providers are in network.
-SHIP counselor/leadership
Partners highlighted challenges in serving members with both Medicare and Medicaid
What's most challenging
Health plans and partners who help members get care shared what was most challenging:
- Unaligned members who get Medicare coverage from one plan and Medicaid coverage from a different plan (62%)
- The state's complex landscape of long-term care and Medicare and Medicaid coverage options that plans help members navigate (24%)
- The lack of community-based resources to support members (14%)
What could help solve challenges
Health plans and partners shared what the Wisconsin Department of Health Services (DHS) could do to make D-SNPs better for members:
- Facilitate enrollee alignment across Medicare and Medicaid products offered by the same company (86%)
- Provide different counseling supports to help members with both Medicare and Medicaid navigate health plan coverage options (77%)
- Expand the number of counties where Family Care Partnership is offered (77%)
Reinforce and enforce continuity of care as it’s required by CMS. Plans need to communicate and have warm hand offs to make sure member doesn’t experience transition stress.
-Health plan representative
Members shared what they need
What's most important
Members and caregivers shared what is most important to them when choosing Medicare and Medicaid coverage:
- Having their Medicare and Medicaid benefits work together (70%)
- Finding a list of doctors and providers so they can keep their current health care providers (70%)
- Understanding costs (66%)
- Knowing what Medicare and Medicaid options are available (65%)
- Understanding Medicare and Medicaid benefits (62%)
Care coordinators are critical
A majority (94%) of members said having a care coordinator is helpful. These professionals help members find local resources, access covered services, and coordinate benefits with other insurance coverage.