Editing Medicare dual eligible (section)

== Historical challenges with the dually-eligible ==
Historically, one of the major challenges for the dually-eligible has been care coordination between Medicare and Medicaid. These two systems of care do not "talk to each other" systematically, so one physician that bills primarily through Medicare may not be familiar with benefits that are available through Medicaid.<ref name=":1">{{Cite book|title = Healthcare Changes and the Affordable Care Act|last = Powers|first = J.S.|publisher = Springer International Publishing|year = 2015|location = Switzerland|pages = 117–131}}</ref>  Additionally, since Medicaid benefits vary by state, it is difficult for care providers and consumers to understand the complexity that is inherent within the Medicaid system.

Because duals tend to be the most vulnerable, and often sickest, adults, their care has historically been expensive, totaling $319.5 billion in 2011.<ref name=":0" />  One proposed reason for this significant cost would be that many Medicaid programs, prior to the 2010 passage of the Affordable Care Act (ACA) used a fee-for-service model.<ref name=":1" />  Fee-for-service models are typically more costly because they allow providers to charge for the quantity of care they provide, rather than the quality.<ref>{{Cite journal|title = Capitation, salary, fee-for-service and mixed systems of payment: effects on the behavior of primary care physicians|last = Gosden|first = T|date = 2000|journal = The Cochrane Database of Systematic Reviews|doi = 10.1002/14651858.cd002215|pmid = 10908531|pages=CD002215|issue=3|pmc = 9879313}}</ref>

In order to resolve these pain points, the ACA includes provisions that specifically address the coverage and care of duals.  On a federal level, the Centers for Medicare and Medicaid Services (CMS) has established two new offices: The Federal Coordinated Health Care Office (FCHCO aka the "duals office") as well as the [[Center for Medicare and Medicaid Innovation]] (CMMI) in order to both strategize and monitor the type and quality of care afforded to duals.<ref name=":1" />  These offices focus on both monetary expenses as well as care innovation and quality for dual eligible beneficiaries.