- 1 in 5 Medicare beneficiaries also rely on Medicaid. These 11 million enrollees tend to have more complex care needs and account for greater expenditures than the average Medicare beneficiary. They are often referred to as dually eligible beneficiaries.
- State Medicaid programs are now investing in significant reforms of care for this dually eligible population, focused on substituting improved care coordination and less-intensive, more person-centered interventions, including home- and community-based services (HCBS), for the major expenses associated with future, downstream hospital and specialty care.
- Medicaid per capita cap legislation would result in a gap between each state’s statutorily determined capped amount and the changing cost of care—generating greater overall budget pressure on state Medicaid programs.
- Under this pressure, states would have an incentive to roll back their ongoing investments in these Medicaid reform initiatives—shifting costs and utilization back toward the Medicare programs’ hospital and post-acute benefits