National Committee for Quality Assurance: Integrated Care for People with Medicare and Medicaid – A Roadmap for Quality

The lack of coordination between Medicare and Medicaid for people who have coverage in both programs is well documented. This group incurs high levels of spending in both programs. Because of the complexities of different coverage and program administration requirements, states have found it challenging to work with plans and providers to create programs that provide the full range of services that people with Medicare and Medicaid need.

Dual Eligibles, Person-Centered Care, Care Coordination

More than 9 million Americans are enrolled in both the Medicare and Medicaid programs. Often, the care provided to these beneficiaries is fragmented and there is misalignment of administrative, regulatory, statutory and financing systems. Health care costs for people with Medicare and Medicaid are twice as high as for people with Medicare alone. In the Medicaid system, these costs also are greater than for the average Medicaid beneficiary, primarily because of spending for long-term services and supports. Better care for people who have Medicare and Medicaid has the potential to improve outcomes and to lower health-care spending.