The District Dual Choice program is exclusively for dually eligible beneficiaries and aims to better coordinate their Medicare and Medicaid benefits. The District intends to expand its existing Dual Choice program into a more comprehensive program in 2022 that integrates Medicare and Medicaid benefits into a single program. That means that there will be ONE set of comprehensive benefits and ONE accountable entity to coordinate the delivery of services to help coordinate the unique needs of individuals. This will further simplify health care for participants and promote greater care coordination.
Who are Dual Eligible Beneficiaries?
Dual eligible individuals are 21 years of age or older, receive both Medicare (Parts A, B, and D), and Medicaid coverage. There are approximately 37,000 dual beneficiaries in the District.
How do I know if I am already enrolled?
If you are enrolled in the Medicare program, you may have a “red, white and blue card” that is your Medicare enrollment card; if you are enrolled in a Medicare Advantage plan, you will have a health plan card that reflects the plan with which you’re enrolled (e.g., Kaiser Permanente, Aetna, etc.). UnitedHealthcare and Cigna HealthSpring are the two private health plans that currently offer Dual Choice enrollment for District Medicaid enrollees.
What changes will be made in the District Dual Choice Program?
The District intends to integrate Medicaid services into Dual Choice current coverage and financing responsibilities. Right now, the Dual Choice plans only pay for Medicare services, and this may inadvertently lead to gaps in care, duplicative services paid by Medicare and Medicaid, and difficulty navigating the two programs’ coverage and services. DHCF expects that improved integration between coverage for this vulnerable population will improve the patient experience, enhance care coordination, and ultimately lead to better outcomes and satisfaction with care and coverage.