Dually eligible beneficiaries are people enrolled in both Medicare and Medicaid who are eligible by virtue of their age or disability and low incomes. This is a diverse population that includes people with multiple chronic conditions, physical disabilities, mental illness, and cognitive impairments such as dementia and developmental disabilities. It also includes individuals who are relatively healthy.
Medicare is the primary payer for acute and post-acute care services. Medicaid wraps around Medicare by providing assistance with Medicare premiums and cost sharing and by covering some services that Medicare does not cover, such as long-term services and supports (LTSS).
There were 10.7 million dually eligible beneficiaries enrolled in both programs in calendar year 2013, the most recent year of comprehensive data for both programs. A majority were:
- female (61 percent),
- age 65 and older (58 percent),
- white (57 percent), and
- had at least one limitation on their activities of daily living (56 percent).
Dually eligible beneficiaries accounted for a disproportionate share of spending:
- In Medicare, they account for 34 percent of spending and 20 percent of enrollees.
- In Medicaid, they account 32 percent of spending and 15 percent of enrollees. In 2013, combined Medicare and Medicaid spending on dually eligible beneficiaries totaled $312.4 billion of which Medicaid accounted for $118.9 billion (38 percent).
- Delivery system
- Integrated care for dually eligible beneficiaries
- Financial Alignment Initiative
- Medicare Advantage dual eligible special needs plans aligned with Medicaid managed long-term services and supports
- Program of All-Inclusive Care for the Elderly
- Medicare Savings Programs
The federal government and states are testing a variety of models to integrate care for beneficiaries enrolled in both Medicare and Medicaid. They include the Program of All-Inclusive Care for the Elderly, the Financial Alignment Initiative (FAI), Medicare Advantage dual eligible special needs plans and fully integrated dual eligible special needs plans, managed long-term services […]
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MACPAC contracted with Health Management Associates (HMA) to examine care coordination requirements for several types of integrated care models: managed long-term services and supports programs that require integration with Medicare Advantage dual eligible special needs plans, fully integrated dual eligible special needs plans, and the Financial Alignment Initiative. This report summarizes the results of HMA’s […]
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Dually eligible beneficiaries receive both Medicare and Medicaid benefits by virtue of age or disability and low income. The design of the programs creates particular challenges for efficient, effective health care delivery. The existence of separate funding streams can create barriers to coordination of care for dually eligible beneficiaries, which in turn can lead to […]
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