MaineCare Benefits - Eligibility, Medicare Benefits - Eligibility
This report is one of a series of reports prepared by the USM Muskie School on MaineCare members who are dually eligible for MaineCare and Medicare Services. This first report provides a high level overview of the MaineCare and Medicare use and expenditure patterns for all members who were dually eligible in state fiscal years (SFY) 2008-2010. This report provides baseline data on the characteristics of Medicare-MaineCare members who are dually eligible, the distribution of expenditures across categories of service for MaineCare and Medicare, and the cost of care for people with select chronic conditions. The report includes information on members considered full benefit as well as those who are partial benefit members. Partial benefit members are also know as Qualified Medicare Beneficiaries, Specified Low Income Medicare Beneficiaries; Qualified Individuals; and Qualified Disabled and Working Individuals. Individuals who are dually eligible for MaineCare and Medicare typically have multiple chronic conditions, high medical and long term care costs, and low income. Medicare covers hospital, medical, skilled long term care and pharmacy services while Medicaid pays for behavioral health, community based long term services and supports and nursing home services. The integration of services and benefits for people who are dually eligible is a challenge for states and the federal government. As states move to introduce value based purchasing initiatives through health homes, accountable care communities and other managed care efforts, the need to coordinate services and align incentives between the Medicaid and Medicare programs becomes increasingly critical. Many states are involved in dual eligible demonstrations to improve the integration of services, benefits and care.
Funding Organization or Grant
Funding for this document was through two Cooperative Agreements with the Maine Department of Health and Human Services and the University of Southern Maine. The analysis of the MaineCare and Medicare data and the preparation of this report were conducted under Cooperative Agreement CA-C0-11-228 with funding from the State Profile Tool grant CFDA 93.779 from the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Funding to link the Medicare and MaineCare data and acquire a license from JEN Associates to use their iMMRS data analytics tool was provided through Cooperative Agreement CA-QI-11-255 with funding provided by the Maine Health Access Foundation.
McGuire C, Gressani T, Bratesman S, Fralich J, Griffin E. Members Dually Eligible for MaineCare and Medicare Benefits: MaineCare and Medicare Expenditures and Utilization, State Fiscal Year 2010. (Chartbook). Portland, ME: University of Southern Maine, Muskie School of Public Service; October 2012.