State Demonstrations to Integrate Care for Dual Eligible Individuals

The Medicare/Medicaid Coordination Office and the Center for Medicare and Medicaid Innovation (Innovation Center) are partnering to bring this opportunity to states. The Medicare/Medicaid Coordination Office and the Innovation Center will work closely with the Center for Medicare (CM), the Center for Medicaid, CHIP and Survey & Certification (CMCS) and other partners across the Centers for Medicare and Medicaid Services and the Department of Health and Human Services (HHS) on this initiative.

Overview

Under the State Demonstrations to Integrate Care for Dual Eligible Individuals, fifteen states across the country have been selected to develop new ways to meet the often complex and costly medical needs of the approximately nine million Americans who are eligible for both the Medicare and Medicaid programs, known as “dual eligibles.”

States received funding to design strategies for implementing person-centered models that fully coordinate primary, acute, behavioral and long-term supports and services for dual eligible individuals. States will work with beneficiaries, their families and other stakeholders to develop their demonstration proposals. The goal of the program is to eliminate duplication of services for these patients, expand access to needed care, and improve the lives of dual eligibles, while lowering costs. 

15 States were selected to receive up to $1 million to support the design of programs to better coordinate care for dual eligible individuals.

See the details of these state efforts.

Background

There are around 9 million individuals who are dual eligibles; that is, eligible for both Medicare and Medicaid. While this 9 million represents a small percentage of the approximately 100 million people enrolled between the two programs, they account for a disproportionate amount of spending (about $300 billion a year) across both programs. For example, dual eligible beneficiaries account for 16 percent of Medicare enrollees but 27 percent of Medicare spending; in the Medicaid program, individuals dually enrolled make up 15 percent of the program but account for 39 percent of costs.

For more information on State Demonstrations to Integrate Care for Dual Eligible Individuals, please visit the State Demonstrations to Integrate Care for Dual Eligible Individuals page.