MassHealth Fact Sheet – FY 2011 H.2
Duals Project

Overview 

The Duals Project is exploring the establishment of an integrated care model for 
younger Dual Eligible residents between the age of 21 and 64 years that will 
address their varying levels of clinical and long-term care needs. Currently, 
younger Dual Eligibles are not eligible to enroll in any of the MassHealth 
managed or integrated care programs. The new Medicare and Medicaid integrated 
care model will be offered to Dual Eligibles on a voluntary enrollment basis. 

Dual Eligibles have complex care needs and face challenges navigating the 
complexities of the Medicare and Medicaid programs, resulting in worse health 
outcomes and higher spending. Neither Medicare nor Medicaid is focused on the 
full range of service needs or the overall cost of services for Dual Eligibles. 

In SFY 2009, there were approximately 233,720 Massachusetts residents eligible 
for both Medicare and Medicaid. Of these Dual Eligibles, 47.4% were between the 
ages of 20 to 64 years old, and 52.5% were 65 years or older.  The SFY2010 
budget projects that services for Dual Eligibles, who make up 18.5% of the 
state’s Medicaid enrollment, will account for 43.5% of the Medicaid budget. 

Integrated Medicare and Medicaid programs hold the potential to improve the 
effectiveness and efficiencies of providing medical and support services, 
improve quality and reduce overall spending 

FY2011 Policy Initiative 

In FY2011, the Duals Project seeks to gain authority from the federal government 
to implement a Fully Capitated Integrated (FCI) Model for Dual Eligibles between 
the age of 21 and 64 years old. The FCI Model will offer comprehensive, 
integrated service delivery that aligns and integrates Medicare and Medicaid 
programs and financing and creates accountability for the delivery, 
coordination, and management of health and community support services that 
promote improved outcomes for members and advance living with dignity and 
independence in the community. Key stakeholders will be involved in the 
development of the model design. 

The key features we seek for the FCI Model are the full integration of the 
Medicare and Medicaid programs and financing, as well as the ability to 
administer the Medicare and Medicaid benefit jointly, such that Dual Eligible 
individuals will experience their Medicare and Medicaid coverage as a single, 
integrated care program.