People dually eligible for both Medicare and Medicaid often face fragmented care.

More than 12 million Americans are enrolled in both Medicaid and Medicare. These dually eligible beneficiaries often have complex health needs and face challenges navigating two distinct health care systems. Integrated care models aim to align services across both programs to improve outcomes and reduce inefficiencies. However, little is known about how beneficiaries themselves experience these models. The Medicaid and CHIP Payment and Access Commission (MACPAC) sought to better understand these experiences to inform future policy decisions. This work supported MACPAC’s goals of increasing enrollment in integrated care, expanding availability, and improving integration within existing models.

NORC conducted focus groups to gather insights from dually eligible beneficiaries.

NORC designed and implemented a qualitative study to explore the experiences of full-benefit dually eligible beneficiaries enrolled in integrated care models. We conducted 10 focus groups across five states, engaging participants enrolled in various plan types, including Medicare-Medicaid Plans (MMPs), Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs), Highly Integrated Dual Eligible Special Needs Plans (HIDE SNPs), and Coordination-Only D-SNPs. Focus groups were conducted virtually to maximize accessibility and safety, with accommodations for participants with limited technology access. Focus groups explored topics including plan enrollment, care coordination, beneficiary protections, and the impact of benefit carve-outs. Our person-centered approach ensured participants felt comfortable sharing candid feedback.