Affordable Care Act Provisions Relating to the Care of Dually Eligible Medicare and Medicaid Beneficiaries

This issue brief identifies the major provisions in the Patient Protection and Affordable Care Act (ACA) that are designed to improve care and streamline service delivery for dual eligibles, the millions of low-income seniors and younger persons with disabilities who are enrolled in both the Medicaid and Medicare programs. Dual eligibles are among the sickest and poorest individuals covered by either the Medicaid or Medicare programs; they comprise only 15 percent of total Medicaid enrollment yet represent 39 percent of annual Medicaid expenditures. Similarly for Medicare, duals represent 21 percent of Medicare enrollees but 36 percent of Medicare expenditures. Medicare primarily pays for dual eligibles’ acute and hospital care, and prescription drugs, while Medicaid generally helps to pay for their Medicare premiums, cost sharing and long-term care, as well as other non-medical services.

The ACA presents an array of new and enhanced options to improve care for dual eligibles: through better care integration, improved quality measures, and increased access to home and community-based long term services and supports. This brief identifies major provisions in the ACA that relate to the care of dual eligibles, highlighted below.

Issue Brief (.pdf)