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Among Dual Eligibles, Identifying The Highest Cost Individuals Could Help In Crafting More Targeted And Effective Responses

This Health Affairs article by researchers at the Urban Institute analyzes linked Medicare and Medicaid data to examine dual eligibles’ utilization and spending in both programs in 2007. It finds that while the population of people dually eligible for Medicare and Medicaid is indeed costly, it is not monolithic. For instance, although 20 percent of dual eligibles accounted for more than 60 percent of combined Medicaid and Medicare spending, nearly 40 percent of dual eligibles had lower average per capita spending than non-dual-eligible Medicare beneficiaries. Fewer than one percent of dual eligibles were in high-cost categories for both Medicare and Medicaid.

The findings suggest that decision makers should tailor Affordable Care Act initiatives to account for subpopulations of dual eligibles, their costs, and their service use.

Health Affairs Article