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Dual Eligible Demonstrations: Resources for Advocates


In April 2011, the Centers for Medicare and Medicaid Services (CMS) awarded $1 million grants to 15 states for the design of integrated service delivery and payment models for dual eligibles, people with high health care needs who are enrolled in both Medicare and Medicaid. CMS has emphasized that consumer stakeholders must be included in the planning processes. A new Commonwealth Fund–supported Web site,, offers educational resources for consumer groups and can serve as a platform for sharing ideas and strategies for improving care for dual eligibles. 

The Problem

States are struggling to find ways to engage consumers in the development of integrated models of care for people with Medicare and Medicaid. At the same time, consumer representatives say they need resources to help them gain a better grasp of the technical design and implementation issues involved.


Health care consumers and state consumer advocates

The Intervention

The Web site is a resource for consumers and advocates that provides background information, links to news and events, and, in the Advocate Tools section, concrete recommendations to help advocates work with state policymakers to ensure that new delivery models improve care for dual eligibles. The Advocate Tools cover such topics as the development of the appeals process if health plans or providers deny needed care; patient assessment and care planning; consumer protections; and provider payment models. The site also offers state-by-state information about the dual eligibles population and the demonstration projects that local policymakers are considering. The site also features a custom search tool to direct users to the most valuable resources on the Web about dual eligibles..

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