Tool for People with HIV: Medicare-Medicaid Dual Eligibility


From the ACE TA Center Listserv

You asked, we listened: New resource for people with HIV on Medicare-Medicaid dual eligibility now available.

To kick off the New Year, the ACE TA Center is excited to announce the launch of our new tool, Understanding Dual Eligibility: A Guide for People with HIV About Medicare and Medicaid Coverage.

This tool will allow Ryan White HIV/AIDS Program (RWHAP) clients to better understand the basics of Medicare-Medicaid dual eligibility, including how they became or will become dually eligible, the enrollment process, the benefits of being enrolled in both programs, how to find financial help for their health care costs, and how to fully utilize their health coverage for their HIV and non-HIV related health needs.

Dual eligibility is when a person is eligible to enroll in and receive coverage from both Medicare and Medicaid, and the eligibility and enrollment specifics can sometimes be complex.

Developed by the ACE TA Center and reviewed by ACE’s Field Expert Panel, this tool covers the following:

  • Medicare and Medicaid eligibility criteria
  • Common pathways to dual eligibility
  • Important health coverage priorities for dually eligible RWHAP clients, including access to HIV and non-HIV providers, medications, and support services
  • Common health coverage considerations for dually eligible RWHAP clients, including:
    • The key elements and importance of care integration and care continuity
    • The order of payors for dually eligible individuals
    • The role of RWHAP and RWHAP Part B ADAP in supporting dually eligible clients with Medicare and Medicaid premiums, cost-sharing, and copays
  • Sources of financial help, such as Medicare Savings Programs and the Extra Help program
    How to discuss health coverage and enrollment needs with case managers or HIV providers and get connected to enrollment support

This tool is also available in Spanish and Haitian Creole.

Did you know? ACE also has a tool on dual eligibility for RWHAP staff, case managers, and program administrators.

Launched in 2022, The Fundamentals of Medicare-Medicaid Dual Eligibility for Ryan White HIV/AIDS Program (RWHAP) Clients was designed to help case managers better understand the health coverage needs of their dually eligible clients. This tool covers many of the same topics as the one above for clients, however from the standpoint of the case manager. The case manager tool also includes information on how they can assist clients with enrolling and accessing coverage as well as how to build the capacity of their RWHAP staff to support dually eligible clients.  

Have a question? Email us at [email protected].

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