Coordinating and Improving Care for Dual Eligibles in Nursing Facilities Current Obstacles and Pathways to Improvement

More than half of all nursing facility residents are dually eligible for both Medicare and Medicaid, enmeshing them in a system of care and coverage that is complex, fragmented, uncoordinated, and inefficient. This policy brief suggests that coordination of care for these dual eligibles could be improved by shifting responsibility for long-term nursing facility services from Medicaid to Medicare. Some incremental steps could also increase accountability for prescription drug use, reduce avoidable hospitalizations, cut costs, and improve overall care. It is important to ensure that Medicaid home- and community-based service programs and nursing facility care remain coordinated for those who can be cared for in the community.