Health Topics

• Health Care Reform
  
• Medicare
  
• Medicaid and CHIP
  
• State Health Policy
  
• Quality and Health System Functioning
• Costs and Payment Policies
• Mental Health and Substance Abuse
• Data Development
• Public and Population Health
• Clients

Monitoring Medicare and Medicaid Expenditures for Dual Eligibles

Dual eligibles, individuals simultaneously enrolled in both Medicare and Medicaid, account for a disproportionate share of combined Medicare and Medicaid spending. Duals eligibles are of special interest to policymakers, not only because they constitute a large and costly group, but also because it is unclear how best to coordinate care across the Medicare and Medicaid programs.

Mathematica analyzed Medicare and Medicaid service use of dual eligibles to illuminate the interplay between the two programs, identify the effects of state-to-state variation in Medicaid eligibility and coverage, and approximate the costs incurred by elderly and disabled people not covered by Medicaid. We used Medicare and Medicaid data for dual eligibles in four states (Colorado, Florida, New Jersey, and Virginia) to identify subpopulations of dual eligibles. We also constructed profiles of expenditure and service use within each subpopulation, for long-term care users and nonusers.

We developed a research-quality database on dual eligibles for the Centers for Medicare & Medicaid Services to examine beneficiaries' use of services from Medicare and Medicaid during the 12 months preceding death.

Publications

"Medicaid-Financed Nursing Home Services: Characteristics of People Served and Their Patterns of Care, 2001-2002" (January 2008) Executive Summary
"A Profile of Medicaid Institutional and Community-Based Long-Term Care Service Use and Expenditures Among the Aged and Disabled Using MAX 2002" (January 2008) Executive Summary