COVID-19 has disproportionately affected dually eligible individuals. Medicare data from the Centers for Disease Control and Prevention (CDC) indicated that from January 1, 2020, to November 20, 2021, individuals dually eligible for Medicare and Medicaid health plans had higher rates of COVID-19 cases and hospitalization than those with only Medicare insurance, for every age group, Medicare entitlement group (e.g., age, disability, or end stage renal disease (ESRD) status), race or ethnicity, and gender category.1 Research has shown that COVID-19 vaccination rates for Medicaid enrollees are 15-20 percent lower than for the general population.2
Currently, the public perceives the COVID-19 virus as being less serious than at the start of the pandemic, but the COVID-19 pandemic remains an important public health concern.3 There have been several waves of the infection due to viral mutation.4 The recent Omicron subvariant is more transmissible than prior viral variants.5 According to the National Council on Aging (NCOA), in January 2022 around 95 percent of all new cases in the U.S. were due to the Omicron variant.6
Health officials have urged people to become vaccinated as soon as possible. The updated bivalent booster has been available since September 2, 2022. Previously, the only CDC approved primary vaccines and boosters were monovalent, which offer protection against the original strain of the COVID-19 virus. The updated bivalent booster is unique in that it offers protection against both the original and the Omicron strain of the COVID-19 virus.7 However, COVID-19 booster vaccination rates have declined since the initial wave of Omicron, and slow updated bivalent booster uptake may not prevent an increase in cases during the winter of 2022-2023.8
Dually eligible beneficiaries have a number of health needs that tend to require higher Medicare and Medicaid spending. Seventy percent of dually eligible individuals have chronic conditions including Alzheimer’s disease, diabetes, heart disease, or intellectual disabilities, and 41 percent have behavioral health needs including anxiety, bipolar disorder, depression, or schizophrenia.9 As of March 2020, dually eligible beneficiaries represent 20 percent of total Medicare enrollment but 34 percent of total Medicare expenditures, and 15 percent of total Medicaid enrollment but 33 percent of total Medicaid expenditures.10 In September 2022, Health Affairs noted that dual eligible special needs plans (D-SNPs) have greater expenses due to members’ chronic conditions, disabilities, and complex care needs, including long-term services and supports (LTSS).11 The article also noted that D-SNP beneficiaries face additional challenges related to social determinants of health (SDOH) such as unstable housing, food insecurity, transportation issues, and difficulties accessing medical care. These factors result in poorer health outcomes for members and higher spending for health plans.12 The Commonwealth Fund estimated that if 80% of eligible people receive their COVID-19 booster by December 31, 2022, direct medical costs could be reduced by an estimated $13.5 billion dollars for Medicare and by $4.54 billion for Medicaid.13
To increase the rate of vaccination among dually eligible individuals, health plans should understand the social and economic needs of the members. For Medicaid enrollees, common barriers to obtaining a COVID-19 vaccine at vaccination sites include lack of transportation and scheduling challenges. They prefer to receive a COVID-19 vaccination directly from their physician’s office.14 Thus, it may be necessary to engage medical providers who regularly serve Medicaid recipients to counsel and provide COVID-19 vaccinations to communities. Close coordination between health plans, healthcare providers, and community organizations is crucial to helping dually eligible individuals receive the updated bivalent booster.
Additionally, improving health literacy and awareness regarding the updated bivalent booster will be beneficial. According to a Kaiser Family Foundation study released in September 2022, half of the public has heard “little to nothing” about the updated bivalent booster.15 Health plans can increase COVID-19 vaccination and booster rates by engaging in marketing or outreach efforts, and helping beneficiaries access the updated booster. Directing members to the following resources may be helpful.16
- To find nearest vaccination location:
- Search using zip code at https://www.vaccines.gov
- Text your zip code to 438829 (GETVAX for English) or 822862 (VACUNA for Spanish)
- Call 1-800-232-0233 (TTY 888-720-7489) for English, Spanish, and many other languages
- Contact healthcare providers, pharmacies, and local or state health departments
- For individuals that are homebound:
- Contact your healthcare provider or local or state health departments
- Call 211 to connect to essential community services
- Contact advocacy groups and organizations:
- The Aging Network at 1-800-677-1116
- Eldercare Locator at 1-800-677-116 (or search using zip code at eldercare.acl.gov)
- The Disability Information and Access Line at 1-888-677-1199
- The Medicare recipient hotline at 1-800-633-4227 (TTY 1-877-486-2048)
The following resources from Resources for Integrated Care focus on vaccination strategies for dually eligible individuals that are homebound:
- Home-Based COVID Vaccination: Tips for Health Plans blog post, which describes approaches that health plans can use to facilitate home-based vaccination for dually eligible members
- COVID-19 Homebound Vaccination Strategies for Dually Eligible Individuals brief, which provides information on strategies supporting improved member identification, enhanced targeted outreach, use of strategic partnerships, and creative data sharing and collection.
For additional information on strategies to improve COVID-19 vaccination rates, please review the following resources:
- Promoting COVID-19 Vaccinations Among Dually Eligible Individuals: August 2022 Update (9/16/2022)
- Building And Sustaining Vaccine Confidence And Uptake (5/19/2022)
- Addressing Barriers to Vaccination For Individuals with Disability (7/8/2021)
1Centers for Medicare and Medicaid Services. (2021). Preliminary Medicare COVID-19 Data Snapshot. Retrieved from https://www.cms.gov/files/document/medicare-covid-19-data-snapshot-fact-sheet.pdf.
2Cooper, R., Fiscus, M., Roth, E., Tewarson, H., Wilkniss, S., Bollinger, J., Greene, K., Huber, K., McClellan, M. (2021). Strategies to Increase COVID-19 Vaccination Rates in Medicaid Enrollees: Considerations for State Leaders. National Academy for State Health Policy. Retrieved from https://healthpolicy.duke.edu/sites/default/files/2021-12/Strategies%20to%20Increase%20COVID-19%20Vaccination%20Rates%20in%20Medicaid%20Enrollees.pdf.
3Fitzpatrick, M. C., Shah A., Moghadas S. M., Vilches, T., Pandey, A., Galvani, A. (2022). A Fall COVID-19 Booster Campaign Could Save Thousands of Lives, Billions of Dollars. The Commonwealth Fund. Retrieved from https://www.commonwealthfund.org/blog/2022/fall-covid-19-booster-campaign-could-save-thousands-lives-billions-dollars.
4Maragakis, L. (2021). Coronavirus Second Wave, Third Wave and Beyond: What Causes a COVID Surge. John Hopkins Medicine. Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/first-and-second-waves-of-coronavirus.
5UC Davis Health. (2022). Omicron: 10 things to know about the very contagious COVID-19 variant. Retrieved from https://health.ucdavis.edu/news/headlines/omicron-10-things-to-know-about-the-very-contagious-covid-19-variant/2022/01.
6Cameron, K. (2022). How Older Adults Can Stay Protected During the Omicron Surge. National Council on Aging. Retrieved from https://www.ncoa.org/article/how-older-adults-can-stay-protected-during-the-omicron-surge.
7Centers for Disease Control and Prevention. (2021). Variants of the Virus. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/variants/index.html.
8Fitzpatrick, M. C., Shah A., Moghadas S. M., Vilches, T., Pandey, A., Galvani, A. (2022). A Fall COVID-19 Booster Campaign Could Save Thousands of Lives, Billions of Dollars. Common Retrieved from The Commonwealth Fund. https://www.commonwealthfund.org/blog/2022/fall-covid-19-booster-campaign-could-save-thousands-lives-billions-dollars.
9Integrated Care Resource Center. (2022). Dually Eligible Individuals: The Basics. Retrieved from https://www.integratedcareresourcecenter.com/sites/default/files/ICRC_DuallyEligible_Basics.pdf.
10Medicare-Medicaid Coordination Office. (2020). People Dually Eligible for Medicare and Medicaid. Centers for Medicare and Medicaid Services. Retrieved from https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/MMCO_Factsheet.pdf.
11Lynch, C. A., Murray, M. A. (2022). To Improve Dual Eligible’ Health, Create Targeted SDOH Funds and Increase Integration. Health Affairs. Retrieved from https://www.healthaffairs.org/content/forefront/improve-dual-eligibles-health-create-targeted-sdoh-funds-and-increase-integration.
13Fitzpatrick, M. C., Shah A., Moghadas S. M., Vilches, T., Pandey, A., Galvani, A. (2022). A Fall COVID-19 Booster Campaign Could Save Thousands of Lives, Billions of Dollars. Common Retrieved from The Commonwealth Fund. https://www.commonwealthfund.org/blog/2022/fall-covid-19-booster-campaign-could-save-thousands-lives-billions-dollars.
14Cooper, R., Fiscus, M., Roth, E., Tewarson, H., Wilkniss, S., Bollinger, J., Greene, K., Huber, K., McClellan, M. (2021). Strategies to Increase COVID-19 Vaccination Rates in Medicaid Enrollees: Considerations for State Leaders. National Academy for State Health Policy. Retrieved from https://www.nashp.org/strategies-to-increase-covid-19-vaccination-rates-in-medicaid-enrollees-considerations-for-state-leaders-report/#toggle-id-2.
15Palosky, C. (2022). Half of Public Has Heard Little or Nothing About the new COVID-19 Booster Aimed at Omicron; Many Don’t Know If the CDC Recommends That They Get the New Booster. Kaiser Family Foundation. Retrieved from https://www.kff.org/coronavirus-covid-19/press-release/half-of-public-has-heard-little-or-nothing-about-the-new-covid-19-booster-aimed-at-omicron-many-dont-know-if-the-cdc-recommends-that-they-get-the-new-booster/.
16Centers for Disease Control and Prevention. (2022). How Do I Find a COVID-19 Vaccine or Booster? Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/vaccines/How-Do-I-Get-a-COVID-19-Vaccine.html.