The Center for American Progress and Community Catalyst released a brief offering suggestions to lower cost and enhance quality of care for dual eligibles under the national health care reform law.  The brief offers five principles for the Centers for Medicare & Medicaid Services (CMS): starting with a well-designed health care delivery system; ensuring beneficiaries have strong protections; engaging beneficiaries and their families in crafting policy; ensuring combined Medicare and Medicaid funds enhance service delivery; and establishing a culture of quality improvement. 

From the report:  

The 8.8 million so-called “dual eligibles,” or individuals who qualify for and are enrolled in both the Medicare and Medicaid public health insurance programs, are some of the sickest and poorest patients in our nation’s health care system. Not surprisingly, they are some of the most expensive patients as well. Policymakers and program managers have long sought solutions for improving the quality and efficiency of care delivered to these individuals. Implementation of the Affordable Care Act, the health reform law enacted in March, 2010, offers new opportunities for achieving these goals by experimenting with different approaches to see what works. One of those options is to allow the states to assume full financial and programmatic responsibility for managing the health care of dual eligibles, in contrast to today’s practice of sharing the financial costs and management challenges related to these patients across two programs— one managed by the states and the federal government (Medicaid) and one managed only by Washington (Medicare)—each with different coverage and payment parameters. Other approaches may be identified and tested through demonstration programs authorized by the new law.

Full Report: The “Dual Eligible” Opportunity: Improving Care and Reducing Costs for Individuals Eligible for Medicare and Medicaid (PDF | 543 KB)

Center for American Progress. (2010). The "dual eligible" opportunity: improving care and reducing costs for individuals eligible for Medicare and Medicaid. Davenport, K., Hodin, R., and Feder, J.