1. ACAP Dual Eligibles Toolkit: Summary Data for Massachusetts
Compiled by: Special Needs Consulting Services (SNCS)

2. Key Information, Massachusetts
Massachusetts has roughly 240,000 “full duals”
52% of these persons are age 65+
The full duals’ annual costs (across Medicaid and Medicare) now total approximately $300 billion – roughly $50,000 per person per year
65% of these expenditures are paid for by Medicaid
SNCS estimates that 10% of the Massachusetts duals’ costs are currently paid via capitation; 90% via FFS
Massachusetts submitted a Memorandum of Understanding to CMS authorizing the Massachusetts Duals Demonstration in August 2012
MCOs interested in serving duals under this demonstration need to engage in significant preparations during CY2012 (and CY2013)
Average lifetime revenue for each dual eligible enrolled is likely to exceed $500,000, since most duals will remain eligible and enrolled for remainder of their lives (which should average > 10 years)
The high needs and high costs, coupled with the “rest of life” enrollment dynamic, creates profound and exciting care coordination opportunities
Moving Massachusetts’ duals into coordinated care also makes market positioning critically important right now for MCOs interested in serving this subgroup

3. Estimated PMPM Cost, Massachusetts Full Duals, 2008
Age <65
Age 65+
All Full Duals
Average Eligibles
109,276
111,485
220,761
Total Medicaid Cost
$1,077
$1,668
$1,375
Nursing Home
$151
$1,065
$612
Capitated Care
$22
$180
$102
HCBS Waiver & Prosthetics
$207
$149
$178
Personal Support
$119
$80
$99
ICF/MR
$101
$42
$71
All Other Medicaid
$477
$152
$313
Estimated Medicare Costs
$1,124
$1,340
$1,233
Part A
$386
$614
$501
Part B
$388
$492
$441
Part D
$350
$233
$291
Total Costs, Medicaid & Medicare
$2,201
$3,008
$2,609

4. Estimated Total Dollar Cost, Massachusetts Full Duals, 2008
Age <65
Age 65+
All Full Duals
Average Eligibles
109,276
111,485
220,761
Total Medicaid Cost
$1,412,351,919
$2,231,194,632
$3,643,546,551
Nursing Home
$197,495,810
$1,424,286,699
$1,621,782,509
Capitated Care
$28,933,176
$241,211,266
$270,144,442
HCBS Waiver & Prosthetics
$271,939,697
$198,694,987
$470,634,684
Personal Support
$155,915,691
$107,264,855
$263,180,546
ICF/MR
$132,467,919
$56,362,195
$188,830,114
All Other Medicaid
$625,599,626
$203,374,630
$828,974,256
Estimated Medicare Costs
$1,474,501,764
$1,792,389,134
$3,266,890,898
Part A
$506,418,298
$822,013,979
$1,328,432,277
Part B
$508,682,523
$658,533,915
$1,167,216,438
Part D
$459,400,942
$311,841,241
$771,242,183
Total Costs, Medicaid & Medicare
$2,886,853,683
$4,023,583,766
$6,910,437,449

5. Publicly Available Resources Containing Data and/or Other Information About Massachusetts’ Dual Eligibles
Medicare-Medicaid Enrollee State Profile, Massachusetts, Centers for Medicare & Medicaid Services
Massachusetts State Demonstration to Integrate Care for Dual Eligible Individuals
Dual Eligibles in Massachusetts: A Profile of Health Care Services and Spending, September 2011, Massachusetts Medicaid Policy Institute & MassHealth
Achieving Optimal Care Coordination for Medicaid/Medicare Dual Eligibles, August 2011, Special Needs Consulting Services (Joel Menges, Jeremy Batt, Kaleigh Beronja, Jessica Wiecezak)