Refocusing Responsibility For Dual Eligibles: Why Medicare Should Take The Lead

This report examines cost and quality issues associated with the 9 million individuals who receive health care benefits from both Medicare and Medicaid (dual eligibles). The report identifies Medicare's opportunities for improving care for dual eligibles, with measures that include:

• Aggressive oversight and "pay for performance" in Medicare Special Needs Plans that serve specialized populations, including one million dual eligibles;
• Greater emphasis on dual eligibles—especially those who need long-term care—in payment and delivery reforms initiated by the Affordable Care Act; and
• Payment adjustments for Skilled Nursing Facilities to prevent unnecessary hospitalizations for nursing home residents, which shift costs from Medicaid to Medicare.