Changes Ahead for "Dual Eligibles"

Friday, June 22, 2012

man_with_glassesAround 9 million Americans are eligible for both Medicare and Medicaid benefits because of age, income, and/or disability.  This group is sometimes referred to as “Dual Eligibles.”

Improving care for patients with "dual eligibility" has become a priority for federal and state policy makers. In 2008 these folks made up 20% of the Medicare population but accounted for 31% of Medicare spending. Likewise, they comprised 15% of Medicaid beneficiaries, yet accounted for 39% of Medicaid costs. People in this group are among the sickest, frailest, and poorest Americans.  They often have multiple chronic conditions and a high demand for both mental health and long-term care services.

The June issue of Health Affairs* highlights some of the issues, as policy makers increase efforts to improve access to benefits, address poorly coordinated care between the programs, and reduce unnecessary spending on these dually eligible patients.  The Affordable Care Act has provided new impetus for finding better approaches, and twenty-six states (including Ohio) are actively exploring different models, many involving managed care.

*Health Affairs is a journal focused on the intersection of health, health care, and policy. Published by Project HOPE, this peer-reviewed journal appears each month in print, with additional Web First papers published periodically and health policy briefs published twice monthly at www.healthaffairs.org.

- Posted by Carol Culley

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