Partial Duals at the End of the Continuous Coverage Requirement: Need and Opportunity

The group of Medicaid programs collectively known as the “Medicare Savings Programs” provide meaningful assistance to low-income Medicare recipients. These programs are designed for people with income or assets too high to qualify for full Medicaid, but who are still in need of assistance. The principal benefit is state payment of the Part B premium, resulting in a monthly refund to the member’s Social Security check.

One challenge advocates often face is the general lack of awareness of these programs. Because of this, Medicare members often don’t know that there is a program that can help them. This results in very low participation rates.

Unfortunately, it is not just the potential participants that overlook these programs. As we come to the end of the continuous coverage requirement, the Department of Health and Human Services and others have projected that as much as 18% of all Medicaid recipients nationally may lose benefits in the next year. To address this, many state Medicaid agencies are working closely with managed Medicaid plans to conduct outreach and offer renewal assistance. But what about the Medicaid recipients who don’t have a Medicaid plan? What about the partial duals?

Medicare members who are enrolled in QMB, SLMB, and QI programs also need outreach and offers of assistance. Without a managed Medicaid plan to provide assistance and with minimal outreach from state Medicaid agencies, it falls to the Medicare Advantage (MA) plan to provide this advocacy. These members need to know that renewals are re-starting, that communications are coming from the state, and where to access help when navigating the renewal process.

Beyond this assistance, there are further opportunities for Medicare Advantage plans to improve the lives of their dual members. Many states are taking the end of the continuous coverage as an opportunity to modify renewal dates. It is important for MA plans to capture this information to better provide assistance going forward. This conversation with the partial dual member is also an opportunity to evaluate if the member might qualify for full dual benefits and provide assistance with the relevant application(s). With increased SNAP and other benefits associated with the public health emergency coming to an end, now is the perfect time to ensure your members are receiving the highest level of benefits for which they are eligible.

At BeneLynk we’re committed to helping our clients serve all members with an integrated and human, social care program. As the continuous coverage requirement comes to an end, we are working to engage all Medicaid recipients, both full and partial, to ensure that they have the highest possible level of benefits and that they keep the benefits they deserve. If you have questions, or if we might be of service, please reach out to us today at sales@benelynk.com.

About the Author

Sean Libby, BeneLynk’s President, has been an advocate for seniors, people with disabilities, veterans, and individuals with low income for over 20 years. At BeneLynk, we are committed to helping managed care plans deliver superior social care solutions to their members. We’re proud to develop and deliver our services in close partnership with our clients. Drop us a note at sales@benelynk.com.