Making Medicare and Medicaid work better together is a key opportunity for state policymakers who want to improve care delivery for low-income older adults and people with disabilities.
Who Are Dual-Eligible Individuals?
Nearly 13 million people in the U.S. are eligible for both Medicare and Medicaid, a population often referred to as “dual-eligible.” These individuals typically have complex health and social needs, and generally become eligible for the two programs due to low income and because they are over the age of 65 or have one or more disabilities. Additionally, among this population:
live below the poverty line
have limitations that impact daily living
use long-term services and supports
are Black or Latino
have one or more inpatient stay per year
Dual-eligible individuals often have multiple chronic conditions and social service needs. Because Medicare and Medicaid were not designed to work together, this population often receives fragmented, uncoordinated care.
Why Integrate Medicare and Medicaid?
Dual-eligible individuals often experience uncoordinated care and poor health outcomes due to fragmented service delivery across Medicare and Medicaid. Although better integration between the two programs can improve the quality and cost of care, only about 21 percent of full-benefit dual-eligible individuals receive care through integrated programs.
While efforts to integrate Medicare and Medicaid have been underway for more than a decade, several factors are increasing the urgency for action:
Renewed investment in community-based care. More than 40 percent of dual-eligible individuals have long-term care needs. While recent federal investments and new opportunities are promoting alternatives to institutional care, without fully integrated models, this population will continue to receive uncoordinated, fragmented care.
Focus on health equity. Black and Latino individuals, who are disproportionately represented in the dual-eligible population, are enrolling in Medicare Advantage plans at a higher rate. Integrated models may present a key opportunity to advance health equity.
Advancing Medicare & Medicaid Integration is designed to provide states with the support to develop and refine integrated care programs that improve care for their dual-eligible populations. Learn more about state funding opportunities.
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