Texas maintains fourth largest dual-enrolled population, latest data shows


Boram Kim


Data released by the Kaiser Family Foundation (KFF) this week showed Texas had the fourth largest number of individuals jointly enrolled in Medicare and Medicaid in the US for 2019, ranking behind California, New York, and Florida. 


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The population grew by more than 60% from the previous year to 788,037 individuals, the largest increase in recent years. These dual-eligible beneficiaries are some of the poorest Americans in the country with the majority of them aged 65 years and older with incomes of less than $20,000, according to KFF analysis. 

Dual-eligibles receive their primary health insurance coverage through Medicare and supplemental assistance through the Texas Medicaid program. 

Meanwhile, the state ranked 28th in spending at $14,865 per dual-eligible enrollee. 

Nationally, this group comprises just 17% of Medicare and 14% of Medicaid but takes up more than 30% of spending overall. Of the 12.5 million Medicare-Medicaid enrollees across the country, 73% are full-benefit enrollees, 49% are people of color, and 44% were in fair or poor health.

Last year, Texas introduced several quality and value-based incentive programs for Medicaid that reward managed care organizations and providers for achieving positive health outcomes for its older enrollees.

These include efforts to improve access and quality in rural areas and the Comprehensive Hospital Increase Reimbursement Program, which provides increased Medicaid payments to hospitals for inpatient and outpatient services provided to persons enrolled in STAR and STAR+PLUS

In a further effort that would improve healthcare access for dual-eligible Texans, Democrats are also working to pass legislation to create a “Live Well Texas” Medicaid waiver program, a state-customized approach that would provide incentives to enrollees to manage their health responsibly. 

Texas remains one of 12 states that have not expanded Medicaid under the Affordable Care Act.