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  • Washington Highlights

    MedPAC and MACPAC Release Updated Data Book on Dually Eligible Beneficiaries


    Mary Mullaney, Director, Hospital Payment Policies

    The Medicare Payment Advisory Commission (MedPAC) and the Medicaid and CHIP (Children’s Health Insurance Program) Payment and Access Commission (MACPAC) jointly released an updated data book entitled Beneficiaries Dually Eligible for Medicare and Medicaid on Feb. 1. The data book details the dually eligible population’s composition, service use, and spending based on calendar year (CY) 2019 claims data. In each section, it compares subgroups of dual-eligible beneficiaries, as well as dual-eligible beneficiaries with non-dual-eligible Medicare and Medicaid beneficiaries. The CY 2019 data represents the first time the data book has used data from the Transformed Medicaid Statistical Information System — a substantial update from the previous edition of the data book, which drew from CY 2013 claims data.

    The data book shows that 55% of individuals dually eligible for Medicare and Medicaid were enrolled only in Medicare fee-for-service (FFS), which was an improvement from 73% in CY 2013. However, dual-eligible beneficiaries were more likely than non-dual Medicare beneficiaries to report being in poor health, and behavioral health conditions were consistently more common in dual-eligible beneficiaries under age 65. Furthermore, per user, Medicare FFS spending for each type of service remains higher for dual-eligible beneficiaries than for non-dual Medicare beneficiaries, with Medicare spending $19,398 per non-dual beneficiary and $23,652 on full-benefit, dual-eligible beneficiaries for inpatient hospital services in CY 2019.