There is little experience and limited data to support policy making on integrated care for dual eligibles.
Coordinating care for the nine million elderly or disabled and low-income people who are dually eligible for Medicare and Medicaid is a pressing policy issue. To support the debate over this issue, we synthesized public data on how services are provided to dual eligibles receiving covered benefits in both programs. Our analysis confirmed that most dual-eligible beneficiaries receive benefits separately for each program through fee-for-service arrangements. Their enrollment in Medicare and Medicaid managed care is growing but still low, with highly uneven experiences across states. Few states or health plans have experience with coordinating care for dual eligibles within an integrated plan. These findings reinforce the need for caution in considering policies that would rapidly give states the responsibility for coordinating dual eligibles' care and coverage. We also found data gaps that warrant prompt attention in order to provide national-level oversight and improve the evidence base for debating and tracking policy changes.
Mathematica Policy Research in Washington, DC, USA. MGold@Mathematica-Mpr.com
Marsha R
MR
Gold
Gretchen A
GA
Jacobson
Rachel L
RL
Garfield
D016208:Databases, Factual; D019033:Delivery of Health Care, Integrated; D004608:Eligibility Determination; D006801:Humans; D008484:Medicaid / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data*; D011050:Policy Making; D013219:State Government; D014481:United States