Care for Dual Eligibles

Efforts are afoot to improve care and lower costs for roughly 9 million people enrolled in both Medicare and Medicaid.

Medicare and Medicaid are the main government programs that provide health insurance to a range of individuals, including the elderly, people with low incomes, and those with certain disabilities. The programs have different funding sources, covered benefits, and management systems.

People who qualify for benefits under both programs, some nine million beneficiaries, are commonly referred to as “dual eligibles.” They frequently have multiple chronic conditions and more than half have cognitive or mental impairments. Yet because of the separate nature of Medicare and Medicaid, care provided to the “duals” is often poorly managed.

The Affordable Care Act created a new Medicare-Medicaid Coordination Office within the Centers for Medicare and Medicaid Services (CMS) in an attempt to make the two programs work together more effectively. The office is testing various approaches to doing so.

This Health Policy Brief describes the debate over how they should be structured and how likely they will be to lower costs, and was published online on June 13, 2012 in Health Affairs.