There are more than 10.7 million Americans who are eligible for Medicare and Medicaid, known as dual eligibles. These are some of the poorest and sickest individuals covered by Medicare and Medicaid. They account for 19 percent of Medicaid’s enrollment in 2010, but 36 percent of Medicaid’s costs. That gulf may widen as more recent data comes in because with the Medicaid expansions, duals will make up a smaller portion of the population but still account for greater spending. Often these people have the most complex conditions that require extensive medical and long-term care needs.
Medicaid is crucial to the care of the dual eligible population. Medicare serves as the primary payer of the medical costs of this population, however there are many services that Medicare does not cover. Many people on Medicare are quick to list these if you ever need to ask. Principally and to my point is that Medicare largely doesn’t cover long-term care services. These are the nursing facility and home care services that allow people to function with daily life. They may not be surgeries or drugs, but effective long-term care can keep people healthier and reduce the amount of acute medical care a person needs. For example, falls are extremely expensive to the acute care system and reducing falls could reduce hospital care costs. So an effective care model in Medicaid’s long-term care program could and often does save Medicare expenses for acute care needs.