Persistence and Drivers of High-Cost Status Among Dual-Eligible Medicare and Medicaid Beneficiaries

Jose F. Figueroa
Zoe Lyon
Xiner Zhou
David Grabowski
Ashish K. Jha
Peer-Reviewed Article
October 2018

Dually eligible beneficiaries account for disproportionate spending within both the Medicare and Medicaid programs. This study analyzed the drivers of cost for these individuals, and identified the types of costs incurred by dually eligible individuals who were persistently high-cost (defined as being in the top ten percent of costs over a three-year period.)

The majority of these dually eligible individuals who were high-cost in one year remained high-cost over the three-year period. Individuals in this persistently high-cost subgroup were more likely to be young, with fewer medical chronic conditions, and greater intellectual impairment than those who had high costs only within a one-year period.  In addition, total annual spending for the persistent high-cost subgroup was over seven times higher than for non-high cost individuals. Among this persistent high-cost subgroup, nearly 70 percent of costs related to long-term care, with less than one percent of costs relating to potentially preventable hospitalizations. These results suggest that strategies to address the high costs of dually eligible individuals should target long-term care spending. 

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