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Medicare Needs to Take the Lead on Dual Eligibles, Report Asserts

By CQ Staff

October 3, 2011 -- A new Urban Institute report says that Medicare should assume the primary responsibility for improving care and reducing costs for dual eligibles rather than relying on state Medicaid programs to come up with solutions.

Dual eligibles are the 9 million Americans who receive their health care from both Medicare and Medicaid, and their complex needs account for more than 40 percent of those federal programs' costs. Putting the states or Medicaid in the lead for their care is "risky" because for most beneficiaries, Medicaid plays a limited and primarily financial role, says the report, which was funded by the Robert Wood Johnson Foundation.

"Medicaid managed care plans lack both experience and capacity to handle the care needs of the most expensive dual eligibles," says the report. It adds that assigning states responsibility over Medicare and Medicaid funds for dual eligibles as authorized by the health care law "would allow states to substitute Medicare funds for expenditures Medicaid would otherwise make."

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