Revisiting Financing and Delivery of Care to Duals: One Size May Not Fit All
October 21, 2011
Carol V. O'Shaughnessy, MA
The duals, individuals eligible for both Medicare and Medicaid, are a diverse group of about 9 million including 5.5 million low-income seniors and 3.4 million people with disabilities under age 65. While some individuals incur very few costs in either program, on average duals are among the most costly beneficiaries in both programs. Duals account for 15 percent of Medicaid enrollees but nearly 40 percent of total Medicaid spending. And they represent 21 percent of Medicare enrollees but 36 percent of total Medicare expenditures. Some experts have argued that better coordination and integration of care for the duals could result in greater efficiencies for both programs as well as higher quality care. Conflicting incentives between the two programs, however, are often cited as barriers to coordination and recent proposals and models to improve care for the duals have incorporated varying degrees of funding integration and shared savings. Speakers at this meeting discussed the characteristics of this diverse population as well as initiatives at the Centers for Medicare & Medicaid Services to integrate Medicare and Medicaid financing for this population.
James M. Verdier
Mathematica Policy Research
Melanie Bella, MBA
Director, Medicare-Medicaid Coordination Office
Centers for Medicare & Medicaid Services
Medicare Payment Advisory Commission (MedPAC), “Coordinating the care of dual-eligible beneficiaries,” ch. 5 in Report to the Congress: Aligning Incentives in Medicare, June 2010.
MedPAC, "Dual-eligible beneficiaries," section 3 of A Data Book: Health care spending and the Medicare program, June 2011.
David Rousseau et al., “Dual Eligibles: Medicaid Enrollment and Spending for Medicare Beneficiaries in 2007,” Kaiser Commission on Medicaid and the Uninsured, December 13, 2010
Centers for Medicare & Medicaid Services, "Financial Models to Support State Efforts to Integrate Care for Medicare-Medicaid Enrollees," updated October 11, 2011.
Kaiser Commission on Medicaid and the Uninsured, "Proposed Models to Integrate Medicare and Medicaid Benefits for Dual Eligibles: A Look at the 15 State Design Contracts Funded by CMS," Policy Brief, August 2011.