Medicaid & SCHIP; Access to Health Care; Chronic Diseases and Conditions; Medicare; Disparities; Discrimination; Disabilities
As health care costs continue to escalate, Congress, the U.S. Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS), state Medicaid agencies, researchers, and policymakers are focusing on identifying new approaches to care delivery and reimbursement for individuals who are dually eligible for both Medicare and Medicaid. Although relatively few in number (9 million), dual eligible beneficiaries are more likely than others to experience poor health, including multiple chronic conditions, functional and cognitive impairments, and a need for continuous care. Sixty-six percent of dual eligibles have three or more chronic conditions; sixty-one percent are considered to be cognitively or mentally impaired. As a result, the dual eligible population, as a whole, is very expensive for both the Medicare and Medicaid programs. In 2006, dual eligible beneficiaries accounted for approximately $230 billion in federal and state spending. This represented almost 36 percent of total Medicare spending and 39 percent of Medicaid spending. Despite this high level of spending, concerns persist with respect to the quality of care these individuals receive, their heightened risk for potentially preventable high-cost episodes of care, and the potential for unmet needs due to differences in the two public programs (Medicare and Medicaid) on which dual eligibles are highly dependent for care.
Thorpe, J. H. & Hayes, K. J. (2011). A new state plan option to integrate care and financing for persons dually eligible for Medicare and Medicaid. Washington, D.C.: Department of Health Policy, School of Public Health and Health Services, The George Washington University.