Helping Dual Eligibles: How State Medicaid Agencies and State Health Insurance Programs Collaborate
5 min read
As states work to better support individuals who are eligible for both Medicare and Medicaid, understanding how agencies collaborate is critical.
To shed light on these partnerships, ADvancing States and the SHIP Technical Assistance (TA) Center, both in partnership with NCOA, launched a two‑part national survey effort in May 2025. The resulting report provides a unique, dual‑perspective snapshot of how State Medicaid Agencies and State Health Insurance Assistance Programs (SHIPs) work together to assist dually eligible individuals.
Why this project was needed
Supporting people who qualify for both Medicare and Medicaid requires navigating two complex systems with distinct rules, data structures, and administrative processes. State Medicaid agencies oversee eligibility, enrollment, and benefits, while SHIPs provide in‑depth, personalized counseling to Medicare beneficiaries and their families. Because the two systems are separate, individuals often fall into gaps, especially when eligibility, enrollment, or Medicare Savings Program (MSP) issues arise.
Previous research and program experience indicated that cross‑agency collaboration varies widely across states, but there was little data capturing how both sides view these relationships. This project was developed to fill that information gap.
About ADvancing States and the SHIP TA Center
ADvancing States represents state aging and disability agencies, including those administering Medicaid long‑term services and supports (LTSS). Through technical assistance and national research, they help states strengthen service delivery and policy alignment.
The SHIP TA Center, supported by the Administration for Community Living (ACL), provides nationwide training, guidance, and technical assistance to State Health Insurance Assistance Programs (SHIP). It works closely with SHIP directors and staff on topics ranging from Medicare policy to volunteer management.
Together, these two organizations were uniquely positioned to collect balanced, bi‑directional information: one survey of state agencies, and one survey of SHIPs.
The two‑survey approach
SHIP Program survey
- Conducted by the SHIP TA Center in May 2025
- Responses from 50 out of 54 SHIPs nationwide
- Included SHIP directors, administrators, and statewide staff
- Focused on the nature of Medicaid relationships, communication practices, data access, and operational challenges
ADvancing States’ survey
- Conducted in May 2025 using a web‑based tool
- 37 respondents, primarily from state aging agencies and Medicaid LTSS agencies
- Focused on Medicaid agencies' interactions with SHIPs, the structure of partnerships, and needs for support or improvement
Together, these surveys create a paired data set that shows how each side experiences the partnership, something not previously available.
Key learnings
The 2025 Medicaid–SHIP collaboration surveys offer the most comprehensive, two‑sided look to date at how these programs work together. The findings show that while partnerships are widespread and highly valued, they are not consistently structured or supported.
With more formal agreements, clearer data‑sharing pathways, and ongoing joint training, states can strengthen the infrastructure needed to better serve dually eligible individuals, and hopefully ultimately reducing confusion, improving access, and creating a more coordinated beneficiary experience.
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