Today, MedPAC and the Medicaid and CHIP Payment and Access Commission (MACPAC) jointly released a data book: Beneficiaries Dually Eligible for Medicare and Medicaid. This is the second edition of this book, updated with 2010 data and new displays of 2007-2010 trends in the dually eligible population’s composition, service use, and spending.
Dually eligible beneficiaries receive both Medicare and Medicaid benefits by virtue of age or disability and low income. This population is diverse. It includes people who have multiple chronic conditions, physical disabilities, and cognitive impairments, but it also includes people who are poor but relatively healthy. Medicare is their primary payer for primary, acute, and post-acute care services. Medicaid provides varying levels of assistance with Medicare premiums and cost sharing and, for many beneficiaries, also provides services not covered by Medicare, such as long-term services and supports (LTSS).
The design of the programs creates particular challenges for efficient, effective health care delivery. The existence of separate funding streams can create barriers to coordination of care for dual-eligible beneficiaries, which in turn can lead to increased costs and poor health outcomes. These issues are of particular concern given the high health needs of dual-eligible beneficiaries and the fact that this relatively small group accounts for a disproportionate share of both Medicare and Medicaid spending.
This joint data book is the result of an effort by MedPAC and MACPAC to create a common understanding of the characteristics of dual-eligible beneficiaries and their use of services, including demographic, expenditure, and health care utilization information. Its purpose is to inform Congress, as well as each commission’s discussions of the policy issues associated with this population.
Here’s a selection of facts and figures you’ll find in the data book:
- Dual-eligible beneficiaries totaled 20 percent of the Medicare population in 2010 but accounted for 34 percent of Medicare spending. (Section 1, exhibit 4)
- Dual-eligible beneficiaries were proportionately less likely to be white (58 percent) than non-dual Medicare beneficiaries (85 percent) in 2010. There were proportionately more African American (20 percent) and Hispanic (15 percent) dual-eligible beneficiaries than in the non-dual Medicare population (8 percent and 5 percent, respectively). (Section 2, exhibit 6)
- In CY 2010, most dual-eligible beneficiaries (79 percent) were enrolled only in Medicare fee-for-service (FFS). (Section 3, exhibit 11)
- Use of Medicaid-covered institutional long-term services and supports (LTSS) among dual-eligible beneficiaries resulted in disproportionately high Medicare and Medicaid spending. The 21 percent of FFS full-benefit dual-eligible beneficiaries who used these services accounted for 36% of Medicare spending and more than half (54 percent) of Medicaid spending on this population in CY 2010. Medicare and Medicaid per user spending for institutional LTSS users in this population was $31,687 and $45,115, respectively. (Section 5, exhibits 17 and 18)
- Cumulative growth in Medicare spending between 2007 and 2010 was 25.4 percent for dual-eligible beneficiaries and 19.9 percent for non-dual beneficiaries, for average annual growth rates of 7.8 and 6.2 percent, respectively. Cumulative growth in Medicaid spending over this period was 16.3 percent for dual-eligible beneficiaries and 29.6 percent for non-dual beneficiaries, for average annual growth rates of 5.2 and 9.0 percent, respectively. (Section 6, exhibit 22)
- Between 2007 and 2010, the full-benefit dual-eligible population grew at a much slower rate than the partial-benefit dual-eligible population. Nationally, average annual growth in the full-dual population was 1.9% over this period, compared to 8.3% in the partial-dual population. (Section 6, exhibit 26)