Enrollment and Characteristics of Dual-Eligible Medicare and Medicaid Beneficiaries in Integrated Care Programs

David E. Velasquez
E. John Orav
Jose F. Figueroa
Peer-Reviewed Article
May 2023


This study examined enrollment trends and characteristics of dually eligible beneficiaries in integrated care programs.


Integrated care programs (ICPs), which coordinate Medicare and Medicaid services, are designed to make coverage for dual-eligible beneficiaries more seamless and address the increased health care spending and lower quality of care that result from the lack of integration of these separate entities.   Currently, there are three primary ICPs: the Program of All-Inclusive Care for the Elderly (PACE), MA Fully Integrated Dual-Eligible Special Needs Plans (FIDE SNPs), and state demonstration Medicare-Medicaid plans under the Financial Alignment Initiative. This study examines how enrollment in the three primary ICPs has changed overtime compared to non-fully integrated care and whether there are differences in the types of beneficiaries who enroll.


The authors examined changes in ICP enrollment between 2013 and 2020 using national data. Results from the study demonstrated that ICPs experienced moderate enrollment growth, with the proportion of dual-eligible beneficiaries in ICPs increasing from 2% in 2013 to 9% in 2020. Beneficiaries in ICPs were more likely to be Black and Hispanic and were less likely to be rural, younger, or disabled.


ICPs offer enhanced coordination and integration of Medicare and Medicaid services for dually eligible beneficiaries and an overall higher quality of care, yet this study found that over 90% of dually eligible beneficiaries are not enrolled in an ICP. The authors highlight the importance for policymakers to continue to monitor enrollment patterns, including demographic characteristics, to track growth in ICPs and less integrated dual-eligible plans in MA as well as evaluate program impact on equity, spending, and quality of care.

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