This case study is part of the Medicare Rights Center’s series on making Medicare and Medicaid work better together, which uses real client stories from Medicare Rights’ national helpline to highlight how gaps in coordination affect access to care. The series is designed to help policymakers, advocates, and beneficiaries better understand the challenges of navigating two separate systems and to identify opportunities to improve integration, reduce confusion, and ensure people can access the full range of benefits available to them.
In Closing Gaps in Benefits and Services, the case study examines how differences in Medicare and Medicaid coverage rules, vendors, and plan structures can create barriers to essential services like transportation. Mrs. W’s experience shows how limited integration and misleading expectations around supplemental benefits can leave beneficiaries with less access to care than before, while Mr. L’s story demonstrates how more aligned or integrated plans can simplify access and reduce administrative burdens. Together, these examples highlight the need for clearer plan information, stronger oversight of supplemental benefits, and greater alignment between Medicare and Medicaid to ensure beneficiaries receive the services they need.
