NCPA - National Center for Policy Analysis

Medicaid and the Dual Eligible Population

July 5, 2012

The label "dual eligible" refers to a client who is eligible for both Medicare and Medicaid due to age, income level and need for long-term care. In recent years these clients have received critical scrutiny because of the high costs associated with their care, prompting the Department of Health and Human Services (HHS) to institute new, cost-effective models for their care, say Arlene Wohlgemuth, Executive Director and director of the Texas Public Policy Foundation's Center for Health Care Policy, and Spencer Harris, a health care policy analyst with the Texas Public Policy Foundation.

The Texas state government has responded by implementing a number of new measures under STAR+PLUS, a program that coordinates care for the majority segment of dual eligibles. Targeting the Aged, Blind and Disabled (ABD) population for better care, STAR+PLUS seeks to implement the HHS mandate while improving coordination between Medicaid and Medicare.

In order to improve care coordination, STAR+PLUS seeks to enact three sweeping policies.

  • First, dual eligibles will be automatically enrolled into a Managed Care Organization, allowing this single entity to coordinate the continuum of care for each client while still being held accountable to the state.
  • Second, the program will integrate Medicaid and Medicare nursing facility payments, helping to end confusion regarding which system is paying for which services.
  • Third, STAR+PLUS supports individuals receiving care in community based settings, a policy that has been shown to result in savings for the state.

Following this outline, Texas can already boast significant results in its provisions of care for dual eligibles.

  • Of the state's 328,500 dual-eligibles, roughly two-thirds (214,500) reside in the urban areas of the state and are enrolled in STAR+PLUS.
  • Texas has seen cost reductions of 22 percent for in-patient care; 15 percent for acute out-patient care (including emergency room care); and 15 percent for non-physician services, ambulatory care, home health and behavioral health.
  • The state has seen 10 percent cost reductions for its Long Term Services and Supports on the whole.

Source: Arlene Wohlgemuth and Spencer Harris, "Medicaid and the Dual Eligible Population," Texas Public Policy Foundation, June 2012.


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