Experience of Health Care and Other Services for Individuals Dually Eligible for Medicare and Medicaid

On behalf of the Medicare-Medicaid Coordination Office (MMCO) at the Centers for Medicare & Medicaid Services (CMS) Mathematica, in collaboration with its partners at Community Catalyst and NASDDDS, is conducting a series of qualitative studies in several states each year to better understand the health care experiences of dually eligible individuals enrolled in an integrated care plan. The studies focus on enrollees participating in the Financial Alignment Initiative (FAI) demonstrations and Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs).

Mathematica leads qualitative research studies through enrollee interviews focused on understanding how dually eligible individuals experience Medicare and Medicaid systems, processes, and services. 

In addition, another type of study includes materials testing, which tests and refines materials used by CMS, states, plans, or providers to communicate with dually eligible individuals and their caregivers. These communication materials, which might range from educational materials to benefit explanations, frequently contain detailed information that help dually eligible individuals make informed choices and understand their rights, including their right to appeal coverage decisions. 

Mathematica uses human-centered design strategies including journey mapping and user personas to better capture the experiences of dually eligible individuals in integrated care plans. Final reports and summary documents describe the methodology, respondents’ characteristics, findings, and resulting recommendations from each study.