Duals Integration & Managed LTSS
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Duals Integration & Managed LTSS


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Approximately 9 million low-income seniors and younger persons with disabilities are enrolled in both Medicare and Medicaid (often referred to as “duals”), and their number is growing as the population ages.  

Close to half of all seniors and younger adults with disabilities who have Medicare as their primary health care live in poverty. That's why changing the way people with Medicare and Medicaid get access to care has become a priority for policymakers. 

In 2011, CMS awarded 15 states with design contracts of up to $1 million each to develop service delivery and payment models that integrate care. CMS invited states to apply for funding to create two innovative approaches that might demonstrate how to better coordinate care and lower costs for the dual population. 

NCOA Position

NCOA is working with federal and state aging and disability advocates—as well as benefits counseling organizations including State Health Insurance Programs, Area Agencies on Aging, and Aging & Disability Resource Centers working with this target population—to ensure implementation with consumer protections as states move forward on integration efforts.

There are significant implications for beneficiary rights around enrollment choices, securing all care and services covered by Medicare and Medicaid, choice of providers and care options, quality of care and outcomes, and long-term services and supports. 


  • Medicare-Medicaid Coordination Office
    The Affordable Care Act established this office to work across federal agencies, states, and stakeholders to align and coordinate benefits between the two programs. It partners with states to develop new care models and improve the way Medicare-Medicaid enrollees receive health care.

  • Dual Eligible Integrated Care Demonstrations: Resources for Advocates
    This site from the National Senior Citizens Law Center provides resources, background information, and tools that advocates need to engage constructively with their states to ensure that new models improve care for dual eligibles.


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