Chronic Disease and Co‐Morbidity Among Dual Eligibles: Implications for Patterns of Medicaid and Medicare Service Use and Spending - Issue Paper

1 3 3 0 G S T R E E T N W , W A S H I N G T O N , D C 2 0 0 0 5 P H O N E : 2 0 2 3 4 7 5 2 7 0 , F A X : 2 0 2 3 4 7 5 2 7 4 W E B S I T E : W W W . K F F . O R G Chronic Disease and Co‐Morbidity Among Dual Eligibles: Implications for Patterns of Medicaid and Medicare Service Use and Spending By Judy Kasper, Molly O’Malley Watts and Barbara Lyons EXECUTIVE SUMMARY With the passage of health reform, new provisions are directed at improving the delivery and coordination of services for persons enrolled in both Medicaid and Medicare, otherwise known as dual eligibles. Dual eligibles constitute a costly segment of beneficiaries for both programs and include individuals with some of the most severely disabling chronic conditions. While the higher costs associated with services to dual eligibles is well‐known, information on how spending distributes across these programs is less understood. This analysis uses linked Medicare and Medicaid data to provide a clearer picture of the chronic physical and mental conditions and multiple co‐morbidities that create substantial needs for medical and long‐term services among dual eligibles, and provides information about the financial contribution of both Medicare and Medicaid in meeting these needs. Findings: Co‐morbidity among dual eligibles is common and more likely for older duals. Three in five dual eligibles have multiple chronic physical conditions and 20 percent have more than one mental/cognitive condition (Figure 1). In contrast, roughly half of all other Medicare beneficiaries have more than one chronic physical condition and only 5 percent have more than one mental/cognitive condition. Almost 2 in 5 dual eligibles have both a physical and mental disease or condition compared to only 17 percent of all other Medicare beneficiaries. Duals age 80 or older are more likely to have multiple chronic conditions compared to younger duals (Figure 2). Half of persons age 80 or older have both physical and mental/cognitive conditions, compared to about a third of younger dual eligibles. Co‐morbidity of physical and mental health conditions increases care complexity and poses additional problems in coordination and access to needed services.