Coordinating care for the dual-eligible population

Many patients who are eligible for Medicare also are eligible for Medicaid. IDSs that deliver care to these patients, called "dual eligibles," face a challenge of conflicting rules and incentives under existing Federal and state laws governing coverage of these patients. Differences in the Medicare and Medicaid payment rules give IDSs a financial incentive to transfer patients from long-term and postacute to acute care settings in situations in which the patients might receive more appropriate care remaining where they are. Many states are implementing pilot programs to allow IDSs to better coordinate care for dual eligibles. Before states begin implementing pilot or statewide programs, IDSs should be involved in the design of the pilot programs, thereby ensuring that the coordinated funding effectively meets an IDS's requirements for optimum care delivery with adequate payment.