Older Adults
Advancing Integration and Innovation in Care
Improving Payment and Delivery for Dual-Eligible Older Adults
Over 12 million Americans are dually eligible for Medicare and Medicaid, mostly older adults with complex needs. Although these “dual eligibles” are a small group, they account for high health care costs and face a fragmented care system often not suited for their needs. Many “near-duals”, or older adults just above the threshold for Medicaid eligibility, also struggle financially to access care. While integrated care models have emerged as a solution to improve coordination and efficiency, enrollment among dual eligibles remains low due to confusion, limited awareness, unequal access, and inconsistent state support. Enhancing alignment between Medicare and Medicaid and expanding integrated care are vital for improving equity and access for dual and near-dual eligible adults.
By The Numbers
35% vs. 19%
Medicare spending on dual-eligibles versus share of enrollees ¹
2 in 10
share of dual-eligibles enrolled in integrated care models ²
27% vs. 13%
Medicaid spending on dual-eligible versus share of enrollees ¹
$493 Billion
combined cost of care for dual-eligibles ¹
Addressing Gaps in Care for Dual-Eligible and Near-Dual Older Adults
The Accelerator is finding a better way to meet the unique needs of dual-eligibles through innovative payment and care delivery transformation. We prioritize evidence-based recommendations to solve system fragmentation and misaligned Medicare-Medicaid incentives — focusing on advancing existing integrated care models like Program of All-Inclusive Care for the Elderly (PACE), Fully Integrated Dual-Eligible Special Needs Plans (FIDE-SNP), and Accountable Care Organizations (ACO), while fostering federal-state alignment and public-private collaboration. Our approach includes:
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Evaluating dual and near-dual-eligible coverage and care across Medicare and Medicaid
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Organizing an Advisory Group to identify potential short and long-term pathways to advance payment and care delivery reform.
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Developing a set actionable recommendations and public resources to promote federal-state alignment and better care for dual and near-dual-eligibles.
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Exploring and scale existing integrated care models like PACE, and FIDE-SNP, and ACOs that deliver coordinated, value-based care.
Duke-Margolis Project Team
Montgomery Smith, MPH
Policy Research Associate
Alida Austin
Policy Research Assistant
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Frank McStay, MPA
Assistant Research Director
Corinna Sorenson, PhD, MHSA, MPH
Assistant Research Director
West Health Project Team
Mark Japinga, MPA
Associate Director, Health Policy
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Preston Choctaw, MSW, MPH
Process Improvement Manager