Because Medicare is the primary payer for dual eligibles, some states have chosen not to focus on this population. There are some, however, that have experimented with programs and funding approaches to improve care coordination and reduce costs for dual eligibles.
For example, the state of Vermont operates as a Medicaid managed care organization, receiving a lump sum payment for each beneficiary enrolled (excluding CHIP and long-term care services). Nearly all of the state’s full dual eligibles are enrolled in this program, and the state is now moving to operate as a Medicare managed care organization in an attempt to further streamline payment and coordination for the dual eligible population.
Given the emphasis on innovation for the dual eligibles in the Affordable Care Act, it is likely that over time, many more states will experiment with new approaches to serving the dual eligibles.
Related FAQs
What Happens to Medicaid Under the Affordable Care Act (ACA)?
Who Are Dual Eligibles?
What Does the Affordable Care Act Do With Regards to Dual Eligibles?
Who Is the Primary Payer for Dual Eligibiles?
How Is Medicaid Financed?
