These older adults and some people under 65 with disabilities are covered by both Medicare and Medicaid. They are sicker and poorer than the population as a whole and they use a disproportionate amount of health care. Many require long-term care in a nursing home or other setting.
Deeper dive
There were 12.2 million people simultaneously enrolled in Medicare and Medicaid in 2018, according to the Centers for Medicare and Medicaid Services. Nearly half (49%) receive long-term care services and support (LTSS), and 60% have multiple chronic conditions.
Because dual eligibles rack up unusually large medical expenses and have high hospital readmission rates, they’ve become an important focus of efforts to trim health care costs and deliver care more effectively.Health Policy legislation created a special office within CMS to address issues concerning dual eligibles. This includes developing new ways of providing care coordination and addressing perverse incentives that contribute to fragmented care, poor quality care, and cost-shifting. The new office works closely with states across the country and the Medicare and Medicaid Innovation Center.
CMS has created a helpful map that details dual eligible enrollment by state. Dual Eligible Special Needs Plans (D-SNPs) are available for certain individuals who are entitled to both Medicare (title XVIII) and medical assistance from a state plan under Medicaid (title XIX). States cover some Medicare costs, depending on the state and the individual’s eligibility.