Dually Eligible for Medicare and Medicaid

Resources for Integrated Care (RIC) partners with health plans, providers, and subject matter experts to identify promising practices and develop actionable technical assistance (TA) resources and trainings that are intended to build providers’ capacity to address the needs of and deliver more integrated and coordinated care to beneficiaries dually eligible for Medicare and Medicaid.

Dually eligible beneficiaries receive both Medicare and Medicaid benefits due to their age or disability, as well as low-income status.[1] As of 2018, 12.2 million individuals were simultaneously enrolled in both Medicare and Medicaid.[2] Dually eligible beneficiaries often have complex and costly health care needs and account for a disproportionate share of spending in both Medicare and Medicaid.[3] The dually eligible population is ethnically and racially diverse and includes individuals with multiple chronic conditions, behavioral health conditions, physical disability, intellectual and developmental disability, as well as individuals who are relatively healthy.[1]  

Additional information about the dually eligible population is included below:

  • Approximately 61 percent of dually eligible individuals are over the age of 65.[4]
  • The dually eligible population is more racially and ethnically diverse than the Medicare-only population. In 2018, 47 percent of dually eligible beneficiaries were of a racial or ethnic minority group compared to 21 percent of Medicare-only beneficiaries.[5] Dually eligible beneficiaries from minority racial or ethnic populations are at higher risk for poor health outcomes and lower quality of care when compared to other Medicare beneficiaries.[5]
  • Eighteen percent of dually eligible individuals report that they have “poor” health status, compared to six percent of other Medicare beneficiaries.[1] 
  • Nearly half of all individuals dually eligible for Medicare and Medicaid need long-term services and supports for help with daily tasks such as dressing, bathing, and eating.[2] 
  • Seventy percent of dually eligible individuals have three or more chronic conditions.[3] 
  • Forty-one percent of dually eligible beneficiaries have at least one behavioral health diagnosis.[2] 
  • Approximately 39 percent of dually eligible beneficiaries have a disability.[5]
  • Approximately eight percent of individuals dually eligible for Medicare and Medicaid under the age of 65 have an intellectual disability or related condition.[1] 

 

 
References

[1] The Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission. (2018). Data Book: Beneficiaries Dually Eligible for Medicare and Medicaid. Retrieved from http://medpac.gov/docs/default-source/data-book/jan18_medpac_macpac_dualsdatabook_sec.pdf?sfvrsn=0

[2] Centers for Medicare & Medicaid Services. (2019). Fact Sheet: People Dually Eligible for Medicare and Medicaid. Retrieved from https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/MMCO_Factsheet.pdf

[3] Centers for Medicare & Medicaid Services. (2019). Medicare-Medicaid Coordination Office FY 2019 Report to Congress. Retrieved from https://www.CMS.gov/files/document/mmco-report-congress.pdf   

[5] Office of the Assistant Secretary for Planning and Evaluation. (2016). Report to Congress: Social Risk Factors and Performance under Medicare's Value Based Purchasing Programs. Retrieved from https://aspe.hhs.gov/system/files/pdf/253971/ASPESESRTCfull.pdf