Press Release

Embargoed Until Contact

April 18, 2012

Sue Ducat
Director of Communications
(301) 841-9962


From Health Affairs


Coordinating Services for Dual Eligibles


Bethesda, MD -- There are nearly nine million people in the United States who receive both Medicare and Medicaid benefits. Recent cost estimates show that this group, known as dual eligibles, accounts for a disproportionate share of spending in both programs. Although the Medicare and Medicaid programs were never intended to work together, a provision of the Affordable Care Act of 2010 established a Federal Coordination Health Care Office to streamline benefits for this group of beneficiaries. A study, released today by Health Affairs as a Web First, examined 2007 costs and services associated with this group and found that although 20 percent of dual eligibles account for more than 60 percent of combined spending for this population, nearly 40 percent of the group had lower average per capita spending than other Medicare beneficiaries.

Among Dual Eligibles, Identifying The Highest-Cost Individuals Could Help In Crafting More Targeted And Effective Responses

By Teresa A. Coughlin, Timothy A. Waidmann, and Lokendra Phadera


Coughlin, Waidmann, and Phadera are affiliated with the Urban Institute Health Policy Center in Washington, D.C.


Support for this analysis was provided by the Kaiser Commission on Medicaid and the Uninsured, Kaiser Family Foundation. The study will also appear in the May edition of Health Affairs. This paper is published under Health Affairs’ ongoing series on long-term services and supports through the span of life, The Care Span, supported by The SCAN Foundation.


The authors obtained the study data from two primary sources: the 2007 Medicare Current Beneficiary Survey and the 2007 Medicaid Statistical Information System Summary File. For complete Medicaid service spending, they matched the Medicaid Statistical Information System service expenditures to those reported on the form CMS-64. What they found was that there were variations among subgroups of dual eligibles. Some of the key study findings include:


· More than 16 percent of dual eligibles live in institutions, compared to 2 percent of other Medicare beneficiaries.


· Per capita spending in 2007 for dual eligibles was $29,868—more than four times the per capita spending of other beneficiaries.


· Only a small number of dual eligibles were high-cost beneficiaries in both programs. For top spending Medicaid dual eligibles, the vast majority of their spending was for long-term care services. For top spending Medicare dual eligibles, most spending was for acute care services.


“These findings suggest that decision makers need to take a multiprong policy approach to improving the value, efficiency, and quality of care provided to dual-eligible beneficiaries,” conclude the authors. “By carefully designing programs to meet the specific needs of different types of dual eligibles, the Medicare and Medicaid programs can improve efficiency and value while maintaining and perhaps improving access to needed services.”

About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically and health policy briefs published twice monthly at You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download weekly Narrative Matters podcasts on iTunes.

The full text of each Health Affairs Web First paper is available free of charge to all Web-site visitors for a two-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund.