A CRS Series on Medicaid: Dual Eligibles Page: 2 of 48
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A CRS Series on Medicaid: Dual Eligibles
The term "dual eligibles" generally refers to individuals who qualify for both
Medicare benefits and all Medicaid benefits offered in their state. Although dual
eligibles represent about one-eighth of Medicaid and one-sixth of Medicare
beneficiaries, the high cost, significant needs, and considerable challenges in
delivering Medicaid and Medicare services to this group have drawn the attention of
both state and federal policymakers.
In FY2002, about 6.6 million individuals were considered dual eligibles
(including those who only received assistance with Medicare premiums and cost-
sharing). These individuals comprise a disproportionate care of Medicaid spending
- representing 13% of Medicaid beneficiaries and 41% of Medicaid spending. In
2002, Medicaid spent $91.7 billion on dual eligibles including $86.5 billion for
Medicaid services and Medicare cost-sharing and $5.2 billion for Medicare
premiums. Of the spending for Medicaid services and Medicare cost-sharing, 69%
was for long-term care services, followed by 17% for prescription drugs.
This report also provides an overview of dual eligible individuals and discusses
the specific role of Medicaid in serving this group. Dual eligibles are more likely to
be female, in a minority group, have less education, and have higher levels of
functional limitations than the average Medicare beneficiary.
Several current issues exist in providing services to dual eligibles, such as the
challenges in coordinating the delivery of Medicaid and Medicare services. Some
efforts have been made by states and the federal government to increase the
coordination of these services; several of these efforts are discussed in the report.
Another significant policy issue is the implications for dual eligibles of the new
Medicare prescription drug benefit enacted by the 108th Congress, (P.L. 108-173).
Starting in January 2006, dual eligibles will be required to enroll in the new Medicare
Part D benefit for coverage of their prescription drugs.
Finally, states must also cover the Medicare premiums and/or cost-sharing for
certain groups of low-income Medicare beneficiaries (some of whom may also
qualify for Medicaid). States also have the option of covering the Medicare
premiums of other individuals who are enrolled in the state's Medicaid program.
Despite the variety of groups covered, identifying and enrolling these low-income
Medicare beneficiaries remains challenging.
To assist Congress in reviewing policy alternatives and understanding the
current status of Medicaid programs, the Congressional Research Service (CRS) is
producing a series of reports on various aspects of Medicaid. This series will address
Medicaid programs and policies. This report is one in that series and will be updated.
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A CRS Series on Medicaid: Dual Eligibles, report, July 6, 2005; Washington D.C.. (digital.library.unt.edu/ark:/67531/metadc811542/m1/2/: accessed October 23, 2018), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT Libraries Government Documents Department.