March 17, 2010

Dual Eligibles: Opportunities to Integrate Care

Adults who are dually eligible for Medicaid and Medicare are among the nation's most chronically ill and costliest patients, accounting for close to 50 percent of all spending within Medicaid and 25 percent within Medicare. Yet, most of the nation's nearly nine million duals receive fragmented and poorly coordinated care. Because Medicare and Medicaid are each governed by their own policies and procedures, dual eligibles must navigate their health care needs across two sets of providers, benefits, and enrollment policies. Efforts to integrate these two programs are challenging since Medicaid and Medicare are governed by their own delivery, financing, and administrative policies and procedures that result in misaligned benefit structures and opportunities for cost-shifting. However, integrating these services offers tremendous promise in ensuring that dual eligible beneficiaries receive the right care in the right setting, rather than receiving care driven by conflicting state and federal rules and siloed funding streams.