Most Dual Eligibles Still Served by Fee-For-Service

June 6, 2012

A new study has found that most low-income people eligible for both Medicare and Medicaid continue to receive benefits separately via fee-for-service arrangements.

The research, conducted by Mathematica Policy Research, was published this month in Health Affairs. The Kaiser Family Foundation and Kaiser Commission on Medicaid and the Uninsured supported the study.

The study found that most states lack experience coordinating care for dual eligibles, and a paucity of data on the state and federal levels makes it difficult to develop policies and systems to provide that care efficiently.

While half of the states attempt to place these patients in managed care programs, enrollment remains fairly low and the lack of data makes it difficult to determine their effectiveness. 

Presently, nine million persons in the United States are eligible for both Medicare and Medicaid benefits, a population that is quite diverse and generally requires costly care. That number is expected to grow as the population ages, making it even more important that efficient care strategies are developed and implemented.  

 “While seeking to improve care for dual eligibles is important, policymakers would be well advised to consider the level of existing experience and how to target integration efforts so they yield benefits for people, the programs and the public budget,” said Marsha R. Gold, lead author of the report and a senior policy fellow at Mathematica.  

The Affordable Care Act created new mechanisms to better serve dual eligibles, but the report cautioned against moving too quickly in placing responsibility for coordinating in the hands of the states.

“Our findings reveal the limited experience of most states with coordinating care for their dual-eligible populations and reinforce the need for caution in considering policies that would rapidly move responsibility for coordinating dual eligibles’ coverage to states,” the authors wrote.

 “Any such shift in policy must be sensitive to the states’ different experience levels and capacities, as well as the scope of their dual-eligible population."

The report recommended a number of areas where more data was needed to better determine the roles of the states and the federal government in better coordinating care for dual eligible populations.

Those included a more accurate determination of the number of full and partial dual eligibles and the coverage each group receives in their respective programs, and the number of dual eligibles enrolled in Medicare Advantage and similar programs.