Better Care for People Dually Eligible for Medicare and Medicaid

The Centers for Medicare and Medicaid Services (CMS) and states spend over $300 billion per year on the care of dually eligible individuals, yet still do not achieve acceptable health outcomes. In a 2016 study of social risk factors in the Medicare value-based purchasing programs, dual enrollment status was the most powerful predictor of poor outcomes. For example, relative to Medicare-only beneficiaries, dually eligible individuals had 10-31 percent higher risk-adjusted odds of hospital readmission across conditions measured in the Hospital Readmissions Reduction Program, and scores were lower for dually eligible individuals on nearly all (17 of 19) beneficiary-level quality measures in Medicare Advantage.