StateStats: Dilemma Over Dual Eligibles: June 2012 | STATE LEGISLATURES MAGAZINE

Fifteen percent of the nearly 60 million Americans covered by Medicaid in 2008 also were enrolled in Medicare. This percentage varied among states, however, from a high of 26 percent in Maine to only about 10 percent in Arizona and Utah.

These “dual eligibles” tend to be sicker and poorer than other Medicare patients. They are more likely to have several chronic diseases, abuse drugs or alcohol, need mental health treatment, have limited mobility and live in a nursing home. About 77 percent meet state income tests to qualify for full Medicaid benefits and cost-sharing assistance.

Medicare covers basic health services, such as physician office visits and hospital care, while Medicaid covers Medicare premiums, deductibles, copayments and, for those who qualify for full Medicaid benefits, prescription drugs and long-term care.

Almost 40 percent of all Medicaid spending in 2008 was on dual eligibles, mostly for their long term care. Because of this disproportionate spending, state and federal governments are working on coordinating care between Medicaid and Medicare to improve quality and reduce costs.

The Patient Protection and Affordable Care Act created new initiatives and an office to study the issue. And states are experimenting with increasing the use of home and community-based services, coordinating care for patients with several chronic diseases, and using medical homes, managed care and other payment alternatives.

—Laura Tobler