Massachusetts Medicaid/Medicare Dual Eligible System: An OPEN MINDS State Profile

Dual Eligibles are individuals who qualify for both Medicare and Medicaid. Dual eligibles are historically a complex population with multiple health and social support needs. 28% of dual eligibles have depression, compared with 12% of Medicare-only enrollees; and 7.66% have schizophrenia, compared with 0.47% of Medicare-only enrollees. Additionally, the cost of providing care to dual eligibles is much higher than the general Medicare and Medicaid population.

Due to this complexity, state Medicaid programs provided services to the dual eligible population through the fee-for-system in the past. More recently, however, states have started to enroll the dual eligible population in Medicaid managed care, as well as develop systems that align Medicare and Medicaid services and financing. Published in August 2018, this report explores these trends in Massachusetts, and includes information on:

1. The total number of full benefit dual eligibles and enrollment by delivery system
2. An explanation of each financing and delivery system that serves dual eligibles
3. The largest Medicare health plans serving dual eligibles
4. Details on new initiatives, and future plans involving the dual eligible population