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 Improving Care Coordination, the case study contrasts the consequences of weak versus effective care coordination across Medicare and Medicaid. Ms. T’s experience shows how limited integration and inadequate plan support can lead to improper billing, unresolved provider issues, and ultimately a disruption in care when her therapist drops her. In contrast, Mr. Y’s story demonstrates how strong care coordination within a fully integrated plan can proactively protect access to critical services, including uninterrupted 24-hour home care. Together, these examples highlight the essential role of care coordination in reducing administrative burden, preventing care disruptions, and improving outcomes for dually eligible individuals.
