Dual Eligibles Linda Elam, Ph.D., M.P.H. Principal Policy Analyst Kaiser Commission on Medicaid and the Uninsured KaiserEDU.org Tutorial March, 2006 Who Are Dual Eligibles? Figure 1 Background Qualify for both Medicare and Medicaid programs; ~7.5 million total
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Linda Elam, Ph.D., M.P.H.
Principal Policy Analyst
Kaiser Commission on Medicaid and the Uninsured
SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey (MCBS) 2002 Access to Care File.
Medicaid Provides Different Levels of Assistance to Low-income Medicare Beneficiaries
Assistance with Medicare Premiums
Full Medicaid Benefits
7.5 Million Total
Eligibility Pathways & Benefits for Mandatory Populations
Eligibility Pathways & Benefits for Optional Populations
Medicaid Pays for 65% of Elderly Nursing Home Residents at Some Point in Their Stay
Primary payer at admission
Medicaid Payment Status Among Elderly Long Term Care Residents (90+ days)
SOURCE: KCMU analysis of 1999 National Nursing Home Survey.
Financing Care for Dual Eligibles, 2000
Total = $131 Billion
SOURCE: KCMU estimates based on analysis of MCBS Cost and Use, 2000
Type of Service:
Hospice and other services
Skilled Nursing Facility and Home Health
Medical Providers, Supplies and Outpatient Hospital
Dual Eligibles 29%
Other Medicare Beneficiaries 71%
Total Medicare Spending = $224.5 Billion
Total Medicare Spending on Duals = $64.3 Billion
Note: Other services includes Rx drugs, dental, long-term care facility stays.SOURCE: KFF analysis of the MCBS 2002 Cost and Use File.
Other Beneficiaries 60%
Total Medicaid Spending = $262.2 billion
Total Medicaid Spending on Duals = $105.4 billion
SOURCE: Urban Institute estimates for KCMU based on analysis of MSIS and Financial Management reports (CMS Form 64).
Dual Eligibles as Percent of Medicare:
Dual Eligibles as Percent of Medicaid:
Total Enrollment = 41.8 Million
Total Spending= $224.5 Billion
Total Enrollment= 51 Million
Total Spending = $232.8 Billion
SOURCE: Medicare data are from KFF analysis of Medicare Current Beneficiary Survey 2002 Cost and Use File. Medicaid data are from KCMU estimates based on CMS data and Urban Institute estimates based on an analysis of 2000 MSIS data applied to CMS-64 FY2002 data.