On January 27, the Kaiser Family Foundation (KFF) released a brief examining the role of Medicare in dual eligibles’ health care. The brief notes that the 9 million individuals who are eligible for both Medicare and Medicaid account for a disproportionate share of spending in both programs and often have greater health care needs and lower incomes than the other Medicare beneficiaries. The brief outlines dual eligibles’ use of Medicare-covered services and examines Medicare spending data for their care. The authors also highlight opportunities to improve health services and care coordination for the dual eligible population, particularly within national health care reform. The brief notes that current policy discussions centered on reducing spending target dual eligible spending as an area for cost savings. The authors suggest that improving care coordination may improve dual eligible care while reducing program costs; however, they contend that policymakers must ensure that dual eligibles’ access to care is not negatively affected by spending reduction.

From the report:  

The 2010 health reform law incorporates a number of provisions designed to improve the quality of medical care for high-need, high-cost populations, including the nine million low-income elderly and disabled people who are dually eligible for Medicare and Medicaid (Exhibit 1). These “dual eligibles” are more likely than other Medicare beneficiaries to be frail, live with multiple chronic conditions and have functional and cognitive impairments. They also face the challenge of navigating two health care programs, Medicare and Medicaid, which do not always work well together because they have different benefits, billing systems, enrollment, eligibility, and appeals procedures, and often different provider networks.

Full Article:  The Role of Medicare for the People Dually Eligible for Medicare and Medicaid (PDF | 468 KB)

Kaiser Family Foundation. (2011). The role of Medicare for the people dually eligible for Medicare and Medicaid.