Adults who are dually eligible for Medicaid and Medicare (the “duals”) are among the nation’s most chronically ill and costliest patients, accounting for close to 50 percent of all spending within Medicaid and 25 percent within Medicare. Yet, most of the nation’s more than eight million duals receive fragmented and poorly coordinated care.
This CHCS policy brief, Supporting Integrated Care for Dual Eligibles, addresses opportunities for integrating care for this high-cost, high-need population. The brief outlines the rationale for integrating care for duals, reasons why integration has been slow to progress, and emerging vehicles to accelerate the pace of fully integrated care. A companion resource paper provides additional details on promising integrated care models and the challenges and opportunities for supporting integrated approaches.
With health reform in the national spotlight, there is an unprecedented opportunity to confront the administrative, financing, and statutory barriers that hinder integrated care options, both via special needs plans as well as new alternative approaches. By working with states to identify creative solutions, federal policymakers can enhance strategies to both improve health outcomes and control growth in Medicaid and Medicare costs for millions of dual eligible beneficiaries.