Carol V. O'Shaughnessy, MA
Providing appropriate and efficient care for the 9 million people enrolled in both Medicare and Medicaid—the "dual eligibles"—is a major policy challenge. Dual eligibles represent a small proportion of each program’s enrollees but account for a disproportionate share of health care costs. Often overlooked, however, is the heterogeneity of health care needs and spending of the dual eligible population and the potentially different approaches to addressing care delivery and costs for specific subgroups. Some dual eligibles are in relatively good health and do not account for significant spending. Others, however, account for significant Medicare spending for acute and chronic medical care costs. Many of these dual eligibles have significant disabilities and incur high Medicaid spending for long-term services and supports (LTSS), primarily in the form of institutional care. This Forum session explored the diverse group of individuals who are eligible for both Medicare and Medicaid. Speakers discussed initiatives by the Centers for Medicare & and Medicaid Services (CMS) to integrate financing streams, improve service delivery, and reduce overall health care costs for this population; examined some of the challenges in serving diverse high cost patient groups; and considered consumer protections that should be in place for those who participate in integrated care models.
- Sally Coberly, PhD
National Health Policy Forum
- Paul F. Soczynski, MBA
Director, Government Services
- Melanie Bella, MBA
Federal Coordinated Health Care Office
Centers for Medicare & Medicaid Services
- Kevin Prindiville, JD
National Senior Citizens Law Center
Medicare Payment Advisory Commission (MedPAC), "Dual-eligible Beneficiaries,"
section 3 of A Data Book: Health Care Spending and the Medicare Program, June 2011.
MedPAC, "Coordinating the Care of Dual-eligible Beneficiaries," chapter 5 of Report to the Congress: Aligning Incentives in Medicare, June 2010.
Gretchen Jacobson et al., "The Role of Medicare for the People Dually Eligible for Medicare and Medicaid," The Kaiser Family Foundation Program on Medicare
Policy, January 2011.
Kaiser Commission on Medicaid and the Uninsured (KCMU), "Dual Eligibles: Medicaid’s Role for Low-Income Medicare Beneficiaries," Medicaid Facts, May 2011.
Kevin Prindiville and Georgia Burke, "Ensuring Consumer Protections for Dual Eligibles in Integrated Care Models," National Senior Citizens Law Center, July 2011.
Judy Feder et al., "Refocusing Responsibility for Dual Eligibles: Why Medicare Should Take the Lead," The Urban Institute and The Robert Wood Johnson Foundation, October 2011.
See also a subsequent Forum session, "Targeting High-Cost Medicare Beneficiaries to Improve Care and Reduce Spending: Finding the Bull’s-Eye" (March 9, 2012).