Dual eligibles, those who qualify for both Medicare and Medicaid, include nine million people who are more likely to suffer chronic conditions—diabetes, cardiovascular disease and Alzheimer’s. According to one study, a dual eligible costs Medicare nearly twice as much as the average Medicare beneficiary. The current payment system prevents either program to control overall costs, and both have incentives to shift costs onto the other. PPACA took steps to fix the disconnect between the two programs by creating the Medicare-Medicaid Coordination Office. Fifteen states are part of a demonstration program to design approaches to better coordinate care and share savings between the two programs. 

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