A recent ATI Advisory report highlights significant health concerns among dual-eligible beneficiaries—those who receive both Medicare and Medicaid coverage. The report reveals that 64% of these individuals have a mental health diagnosis, a strikingly high percentage compared to those covered only by Medicare. This signals a critical need to better address behavioral health within this population, whose complex health conditions often go underserved due to fragmented care systems. Effective Dual-Eligible Behavioral Health Care is essential for improving their health outcomes.
Dual-eligible beneficiaries face greater health challenges overall, experiencing poorer outcomes and numerous barriers when accessing care. One key issue is the division of benefits between Medicare and Medicaid. Often, Medicaid behavioral health benefits are separated—or “carved out”—from other managed care services, which leads to uncoordinated care delivery. This separation means patients frequently must navigate two different systems to receive physical and behavioral health services, creating delays, duplication, or gaps in treatment that negatively impact their health and quality of life. Improved Dual-Eligible Behavioral Health Care models can help close these gaps.
The Impact of Fragmented Care on Emergency Department Use
The consequences of disjointed care models are particularly clear in emergency department (ED) usage. Dual-eligible beneficiaries with mental health conditions are almost twice as likely to visit the ED compared to Medicare-only patients. In 2019, 39% of dual-eligible individuals with behavioral health diagnoses had an emergency visit, while only 20% of Medicare-only beneficiaries did. Emergency departments are costly and often ill-equipped for managing ongoing behavioral health needs, so frequent ED use points to deficiencies in preventive and coordinated care. Access to comprehensive Dual-Eligible Behavioral Health Care can reduce these costly emergency visits.
These statistics emphasize why integrated care models are so important. Coordinating Medicaid and Medicare benefits more effectively can provide seamless access to both physical and mental health services. When care is better coordinated, patients are more likely to receive appropriate interventions earlier, reducing the need for costly emergency care and hospitalizations. Holistic Dual-Eligible Behavioral Health Care ensures patients receive timely and continuous support for behavioral health needs.
Additional Health and Social Challenges
Behavioral health conditions are not the only concern for dual-eligible beneficiaries. Many also face cognitive impairments and developmental disabilities. The report notes that people with intellectual or developmental disabilities are 17 times more likely to be dual eligible than Medicare-only beneficiaries. These conditions require specialized, coordinated care approaches that address a broad spectrum of physical, behavioral, and cognitive needs. Integrating these needs into Dual-Eligible Behavioral Health Care is crucial.
Social determinants of health also significantly affect this population. A large majority of dual-eligible beneficiaries—75%—live below the federal poverty level. Many face food insecurity (45%) and have lower educational attainment (38% have less than a high school diploma). These socioeconomic challenges compound health issues and create additional obstacles to accessing and maintaining quality care. Medicare Advantage plans offering supplemental benefits like food assistance are important tools in improving Dual-Eligible Behavioral Health Care outcomes.
Policy Directions and Industry Innovations
Healthcare organizations and policymakers are increasingly focusing on the dual-eligible population. In June, CareBridge, a Nashville-based healthcare provider, secured $140 million to expand its value-based care model, which aims to improve outcomes for Medicaid and dual-eligible patients through coordinated care approaches. This investment signals growing recognition of the importance of comprehensive Dual-Eligible Behavioral Health Care models that span both Medicare and Medicaid.
At the policy level, the Medicaid and CHIP Payment and Access Commission (MACPAC) recently recommended that states be required to develop and implement strategies to integrate care for dual-eligible beneficiaries. These strategies should encompass eligibility criteria, benefits coordination, enrollment processes, data analytics, and quality measurement—all structured to promote equity and improve care delivery. Such mandates would promote more effective Dual-Eligible Behavioral Health Care nationwide.
Conclusion
Dual-eligible beneficiaries represent a vulnerable group with significant behavioral health and social challenges. With 64% having a mental health diagnosis and many facing cognitive disabilities and social hardships, the need for effective, coordinated Behavioral Health Care has never been greater. Current gaps caused by fragmented Medicare and Medicaid systems lead to poorer outcomes and increased emergency department visits.
Addressing these challenges requires integrating physical and behavioral health services and aligning Medicare and Medicaid benefits. Innovations in care delivery and policy reforms aimed at creating seamless, patient-centered systems will improve health outcomes and reduce costs. Prioritizing Dual-Eligible Behavioral Health Care is essential to ensuring that this population receives the high-quality care and support necessary to improve their lives.
