Medicaid Special Needs and Waiver Participants
Medicaid Special Needs and Waiver participants, ages 18-64, typically have multiple chronic conditions and are home bound.
Medicaid Special Needs and waiver participant populations are the highest cost patients and take up to 25% of most states total Medicaid budgets.
In the state of Minnesota alone, Special Needs and Waiver participants (not including Elderly Waiver enrollees) consist of more than 53,000 individuals. Over 4,000,000 Special Needs and Waiver participants in the U.S. live confined in their homes with chronic conditions like quadriplegia and diseases like bipolar disorder and muscular dystrophy.
Special needs and waiver participants take multiple medications every day. When they forget to take their meds or take the wrong dose, complications that result may require hospitalization. Special needs and waiver participants are also the likeliest to get sick or die from exposure to viruses like COVID-19 and the Flu.
The HealtheMed telemedicine platform and system of care drives improved medication adherence and numerous other patient benefits including early warning detection for Covid-19 which can be a lifesaver for this most vulnerable population.
Americans who are enrolled in both Medicaid and Medicare are referred to as dual-eligible beneficiaries, or Medicare dual eligibles, or sometimes simply duals.
Dual-eligibles are enrolled in both programs when a Medicare enrollee’s income and assets are low enough to qualify them for Medicaid help in paying for some of the costs of Medicare – or to qualify them for full coverage under both Medicare and Medicaid.
These enrollees are commonly broken into two groups:
People who have Medicare but also receive benefits under Medicaid
People who have Medicare but qualify to have Medicaid help pay for expenses such as Medicare premiums and/or cost-sharing
In the United States, approximately 9.2 million people are eligible for "dual" status.
Dual-eligibles make up 14% of Medicaid enrollment, yet they are responsible for approximately 36% of Medicaid expenditures.
Similarly, duals total 20% of Medicare enrollment, and spend 31% of Medicare dollars.
HealtheMed will first focus on Medicaid Special Needs and Waiver participants, and then start serving dual eligibles in the near future.