Medicaid and Medicare dual eligibility

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Some individuals, such as low-income seniors, are eligible for both Medicare and Medicaid; these individuals are known as dual-eligible beneficiaries. For those enrolled in Medicare who are eligible, enrolling in Medicaid may provide some benefits not covered by Medicare, such as stays longer than 100 days at nursing facilities, prescription drugs, eyeglasses, and hearing aids. Medicaid may also be used to help pay for Medicare premiums. According to the Henry J. Kaiser Family Foundation, in 2011 there were about 9,972,300 dual eligibles in the United States, or 15 percent of Medicaid enrollees. While average Medicaid spending per enrollee was $5,790, spending per dual eligible was $16,904.[1][2][3][4][5]

In Maine, 28 percent of Medicaid enrollees were also enrolled in Medicare, the lagest percentage in the country. Utah had the smallest percentage at 19 percent. Meanwhile, Medicaid spending per dual eligible was highest in New York, $30,697. Alabama had the lowest spending at $8,576.

The chart below includes statistics identifying the percentage of Medicaid enrollees within a state that were also eligible for Medicare, as well as the amount spent through Medicaid per dual eligible.

Dual eligible enrollment, fiscal year 2011

State  | Total Medicaid enrollment* | Medicaid spending per enrollee  | Number of dual eligibles  | Dual eligibles as a percent of Medicaid enrollees  | Medicaid spending per dual eligible
Alabama | 839,500 | $4,111 | 212,100 | 20% | $8,576
Alaska | 108,100 | $9,474 | 15,100 | 11% | $27,461
Arizona | 1,350,700 | $7,022 | 146,400 | 12% | $14,824
Arkansas | 543,200 | $5,264 | 128,300 | 18% | $14,983
California | 7,633,100 | $4,468 | 1,294,400 | 11% | $16,053
Colorado | 620,800 | $5,679 | 77,500 | 10% | $21,830
Connecticut | 574,200 | $7,465 | 155,000 | 20% | $22,532
Delaware | 205,500 | $5,949 | 27,100 | 11% | $15,355
District of Columbia | 194,500 | $8,875 | 23,400 | 10% | $25,847
Florida | 3,070,700 | $4,434 | 675,500 | 18% | $12,362
Georgia | 1,508,900 | $3,992 | 303,900 | 16% | $8,603
Hawaii | 257,700 | $5,438 | 36,500 | 13% | $19,150
Idaho | 217,700 | $5,700 | 39,600 | 15% | $14,450
Illinois | 2,606,300 | $4,477 | 364,600 | 12% | $12,243
Indiana | 987,000 | $5,256 | 172,900 | 14% | $18,432
Iowa | 440,900 | $5,491 | 88,500 | 15% | $19,997
Kansas | 337,300 | $5,996 | 68,400 | 17% | $19,056
Kentucky | 796,500 | $5,937 | 194,100 | 20% | $10,770
Louisiana | 1,024,800 | $4,869 | 201,600 | 16% | $10,830
Maine | 287,800 | $5,968 | 104,000 | 28% | $14,069
Maryland | 870,600 | $7,046 | 119,800 | 12% | $21,513
Massachusetts | 1,190,300 | $8,717 | 255,100 | 17% | $29,072
Michigan | 1,901,300 | $5,067 | 290,700 | 12% | $16,062
Minnesota | 860,600 | $7,506 | 149,300 | 14% | $26,713
Mississippi | 619,900 | $5,335 | 162,200 | 21% | $11,070
Missouri | 818,200 | $6,488 | 187,200 | 16% | $18,066
Montana | 105,900 | $7,140 | 19,700 | 15% | $24,206
Nebraska | 205,900 | $5,763 | 44,300 | 16% | $18,816
Nevada | 297,200 | $3,728 | 50,500 | 13% | $10,398
New Hampshire | 133,700 | $7,254 | 34,500 | 20% | $20,565
New Jersey | 969,300 | $8,309 | 208,300 | 20% | $23,100
New Mexico | 507,400 | $5,803 | 69,100 | 12% | N/A
New York | 4,939,800 | $8,901 | 839,300 | 14% | $30,697
North Carolina | 1,443,500 | $5,226 | 335,100 | 17% | $11,215
North Dakota | 65,100 | $8,338 | 16,300 | 19% | $29,027
Ohio | 2,016,300 | $6,855 | 345,300 | 15% | $23,244
Oklahoma | 651,000 | $4,782 | 119,700 | 14% | $12,530
Oregon | 556,600 | $5,908 | 108,500 | 15% | $16,427
Pennsylvania | 2,088,400 | $7,811 | 443,500 | 18% | $19,089
Rhode Island | 171,900 | $9,247 | 41,100 | 19% | $20,661
South Carolina | 701,500 | $4,805 | 160,200 | 17% | $11,589
South Dakota | 102,300 | $5,485 | 22,100 | 16% | $13,835
Tennessee | 1,324,700 | $5,155 | 279,100 | 18% | $10,600
Texas | 3,652,900 | $5,278 | 642,900 | 13% | $12,862
Utah | 273,900 | $4,890 | 30,200 | 9% | $17,765
Vermont | 138,800 | $6,291 | 30,000 | 15% | $10,299
Virginia | 820,700 | $6,224 | 191,700 | 18% | $13,938
Washington | 1,130,600 | $4,993 | 180,600 | 13% | $14,608
West Virginia | 335,600 | $6,315 | 87,200 | 20% | $13,796
Wisconsin | 968,600 | $5,414 | 168,300 | 13% | $24,657
Wyoming | 67,200 | $6,110 | 11,600 | 13% | $26,403
United States | 53,535,000 | $5,790 | 9,972,300 | 15% | $16,904
* Data on Medicaid enrollment figures may differ depending on the source of data and the computational methods used, such as "point-in-time" figures versus "ever-enrolled" figures.
Source: The Henry J. Kaiser Family Foundation, "State Health Facts"

### Spending in detail[edit]

The table below displays data on Medicaid spending on dual eligibles in detail, as well as dual eligible spending as a share of total Medicaid spending for each state. Medicaid spending on dual eligibles in North Dakota amounted to 56 percent of total Medicaid spending, the largest percentage in the country. Vermont had the smallest percentage at 21 percent.[6][7]

Medicaid spending for dual eligibles by service, fiscal year 2011 (in millions)

State  | Medicare premiums  | Acute care  | Prescribed drugs  | Long-term care  | Total  | Share of total Medicaid spending
Alabama | $250 | $245 | $13 | $1,125 | $1,633 | 35%
Alaska | $22 | $70 | $2 | $264 | $358 | 27%
Arizona | $203 | $1,757 | $0 | $31 | $1,990 | 22%
Arkansas | $159 | $646 | $6 | $892 | $1,703 | 42%
California | $2,248 | $7,235 | $245 | $8,949 | $18,677 | 34%
Colorado | $95 | $350 | $8 | $1,013 | $1,466 | 34%
Connecticut | $178 | $412 | $27 | $2,360 | $2,977 | 48%
Delaware | $33 | $63 | $4 | $270 | $369 | 25%
District of Columbia | $34 | $86 | $3 | $396 | $520 | 25%
Florida | $1,122 | $1,927 | $87 | $4,054 | $7,190 | 39%
Georgia | $295 | $366 | $26 | $1,596 | $2,283 | 29%
Hawaii | $57 | $491 | $0 | $58 | $606 | 38%
Idaho | $40 | $133 | $10 | $317 | $499 | 31%
Illinois | $379 | $844 | $58 | $2,716 | $3,997 | 30%
Indiana | $161 | $604 | $25 | $1,795 | $2,584 | 39%
Iowa | $104 | $340 | $11 | $1,077 | $1,532 | 45%
Kansas | $81 | $169 | $9 | $847 | $1,106 | 41%
Kentucky | $212 | $325 | $40 | $1,241 | $1,817 | 31%
Louisiana | $259 | $297 | $36 | $1,370 | $1,962 | 30%
Maine | $114 | $633 | $14 | $539 | $1,299 | 52%
Maryland | $186 | $471 | $14 | $1,549 | $2,221 | 29%
Massachusetts | $407 | $2,146 | $31 | $2,949 | $5,533 | 41%
Michigan | $389 | $1,378 | $32 | $2,157 | $3,956 | 32%
Minnesota | $172 | $1,086 | $17 | $2,121 | $3,397 | 40%
Mississippi | $201 | $377 | $9 | $1,014 | $1,602 | 37%
Missouri | $177 | $847 | $51 | $1,736 | $2,810 | 36%
Montana | $27 | $71 | $2 | $299 | $399 | 41%
Nebraska | $42 | $188 | $7 | $482 | $719 | 42%
Nevada | $72 | $110 | $5 | $247 | $434 | 28%
New Hampshire | $24 | $97 | $7 | $462 | $589 | 46%
New Jersey | $321 | $809 | $37 | $3,133 | $4,300 | 45%
New Mexico | $78 | N/A | N/A | N/A | N/A | N/A
New York | $1,278 | $4,484 | $174 | $16,902 | $22,838 | 43%
North Carolina | $414 | $739 | $45 | $2,148 | $3,346 | 31%
North Dakota | $11 | $42 | $2 | $348 | $402 | 56%
Ohio | $383 | $1,119 | $120 | $4,779 | $6,400 | 41%
Oklahoma | $133 | $284 | $12 | $875 | $1,304 | 30%
Oregon | $142 | $300 | $8 | $1,094 | $1,545 | 35%
Pennsylvania | $550 | $836 | $41 | $5,889 | $7,317 | 36%
Rhode Island | $40 | $432 | $2 | $286 | $760 | 38%
South Carolina | $172 | $495 | $18 | $948 | $1,633 | 34%
South Dakota | $27 | $45 | $1 | $191 | $264 | 34%
Tennessee | $335 | $1,565 | $18 | $663 | $2,582 | 31%
Texas | $1,016 | $2,170 | $85 | $4,166 | $7,438 | 27%
Utah | $33 | $165 | $8 | $259 | $465 | 25%
Vermont | $6 | $173 | $0 | $86 | $264 | 21%
Virginia | $223 | $387 | $16 | $1,700 | $2,325 | 34%
Washington | $308 | $251 | $27 | $1,685 | $2,271 | 31%
West Virginia | $107 | $107 | $12 | $812 | $1,037 | 36%
Wisconsin | $164 | $1,892 | $33 | $1,493 | $3,581 | 49%
Wyoming | $6 | $75 | $1 | $176 | $258 | 47%
United States | $13,489 | $40,190 | $1,462 | $91,765 | $146,906 | 36%
Source: The Henry J. Kaiser Family Foundation, "State Health Facts"

## Medicaid spending in the 50 states[edit]

Click on a state below to read more about Medicaid spending in that state.

Choose your state...AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington, D.C.West VirginiaWisconsinWyoming

http://ballotpedia.org/Medicaid_spending_in_STATE

## See also[edit]

* Healthcare policy in the United States

* Medicaid

* Effect of the Affordable Care Act in the United States

## Footnotes[edit]

1. ↑ The Henry J. Kaiser Family Foundation, "Monthly Medicaid Enrollment (in thousands)," accessed September 4, 2015
2. ↑ The Henry J. Kaiser Family Foundation, "Medicaid Spending per Enrollee (Full or Partial Benefit)," accessed September 4, 2015
3. ↑ The Henry J. Kaiser Family Foundation, "Number of Dual Eligible Beneficiaries," accessed September 4, 2015
4. ↑ The Henry J. Kaiser Family Foundation, "Dual Eligibles as a Percent of Total Medicaid Beneficiaries," accessed September 4, 2015
5. ↑ The Henry J. Kaiser Family Foundation, "Medicaid Spending per Dual Eligible per Year," accessed September 4, 2015
6. ↑ The Henry J. Kaiser Family Foundation, "Dual Eligibles’ Share of Medicaid Spending," accessed January 21, 2016
7. ↑ The Henry J. Kaiser Family Foundation, "Distribution of Medicaid Spending for Dual Eligibles by Service (in Millions)," accessed July 17, 2015

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