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Medicare-Medicaid Integration

Complex Care

When health care is fragmented, patients suffer and costs go up. People are healthier — physically and mentally — when their care is coordinated and their full needs are met.

Health care in the U.S. is broken and disjointed — and nowhere is that more apparent than among a population of individuals who have some of the most significant care needs in the country. About 12 million people in the U.S. are covered by both Medicare and Medicaid. These so-called dual eligible” individuals account for a disproportionately high share of government health spending and often experience poor health outcomes.

Medicare and Medicaid are two different programs that cover different services and are operated by different arms of the government. Separate rules, processes, providers, and benefits make the system difficult to navigate. Our aim is to increase coordination of care for dual-eligible beneficiaries by promoting evidence-based models that provide seamless and integrated care across the continuum of services, including acute care, long-term support services, home care, behavioral health and social services needs. We back the development of state and federal policies that can improve this coordination.

$500B
Total amount of dollars Medicare and Medicaid spent annually on providing care to people who are dually eligible. Source
2x
The amount of dollars we spend on care for people who are dually eligible compared to Medicare- and Medicaid-only eligible individuals. Source
1 in 4
People who are dually eligible live with five or more chronic conditions. Source
2X
Rate of emergency department utilization among people with Medicare and Medicaid coverage compared to those with Medicare only Source