Executive Summary
Individuals who are enrolled in both Medicare and Medicaid are considered ‘dually eligible’ for both programs as a result of their low income, age, and/or disability status. Because of the varying eligibility pathways, dually eligible beneficiaries are a diverse group, including some of the most medically complex and high-cost enrollees, as well as enrollees who are comparatively healthy. In 2021, there were close to 12 million people in the United States dually enrolled in Medicare and Medicaid, of whom approximately 1.5 million resided in California—comprising 13% of the total number of dually eligible beneficiaries in the United States.
The purpose of this analysis is to better understand the circumstances by which Medicare beneficiaries in the state of California may become eligible for Medi-Cal (California’s Medicaid program) and thereby gain dually eligible status.1 Using several data sources, including Medicare claims data from 2016-2020, this study examines questions about the health status and healthcare service use among beneficiaries prior to Medi-Cal enrollment.
