Medicaid, Medicare, and managed care. Case management for dually eligible clients

A dually eligible person is one who qualifies for both Medicaid and Medicare benefits. When elderly persons need acute care services, they enter a different part of the service delivery system where Medicare is the major payer. Typically, this part of the system is disconnected from the long-term care portion. Rather than working together for the maximum benefit of consumers, each part of the system is motivated to guard its resources jealously. Integration of Medicare and Medicaid offers states the opportunity to demonstrate how better care can be provided by using resources more effectively. However, managed care may bring changes in care delivery and new payers for services which may affect the role of case managers.