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Hearing of the Health Subcommittee of the House Energy and Commerce Committee - "Dual-Eligibles: Understanding This Vulnerable Population and How to Improve Their Care"


Location: Unknown

Dual eligibles, those individuals who are eligible for both the Medicare and Medicaid programs, are one of our sickest, poorest, most costly, and most vulnerable populations.

If we are to simultaneously improve and lower the cost of their care, we must do a better job at integrating Medicare and Medicaid benefits and services.

Dual eligibles are unique.

While more than half of dual eligibles live below the poverty line, only 8 percent of Medicareonly beneficiaries have incomes below the poverty line.

Nineteen percent of dual eligibles live in an institutional setting, while only 3 percent of Medicare-eligible only individuals live in such a setting.

They are also more likely to be hospitalized, to go to emergency rooms, and to require long-term care than other Medicare beneficiaries.

According to the Centers for Medicare and Medicaid Services, more than 9 million people fall into the dual eligible category. Forty-three percent of them have at least one mental or cognitive impairment, while 60 percent have multiple chronic conditions.

According to the Kaiser Family Foundation, dual eligibles -- who make up only 15 percent of Medicaid enrollment -- consume 39 percent of total Medicaid spending.

Additionally, in 2005, the Medicare and Medicaid programs spent an average of $20,000 per dual eligible -- almost five times greater than the average amount spent on other Medicare beneficiaries.

These individuals, who have fewer resources and more complicated health care needs, face the added struggle of trying to navigate both Medicare and Medicaid.

Medicare covers their basic acute health care services and prescription drugs, and Medicaid fills in the gaps. Medicaid generally pays the Medicare Part B premium and the cost-sharing for Medicare services.

For some, Medicaid also covers various benefits not covered by Medicare, including long-term care supports and services, dental care, eyeglasses, and other benefits.

Each state determines its own eligibility standards and which benefits will be provided to Medicaid beneficiaries. So, we are able to watch various states experiment with different models and designs to better align the care of dual eligibles.

Currently, 15 states have been selected to receive funding, data, and technical assistance from CMS to develop a more coordinated model of care for dual eligibles.

We can improve the quality of care that dual eligibles receive. We can make their care more efficient and easier for them to navigate. We can do all this while lowering costs to both the federal government and the beneficiary.

I look forward to hearing from our witnesses about which models are being tried in the states and what we have learned so far.

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