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Background <p>Dually eligible individuals, enrolled in both Medicare and Medicaid, have complex medical, social, and behavioral health needs and account for a disproportionate share of spending in both programs. They experience higher rates of poverty, disability, chronic conditions, and behavioral health disorders than Medicaid-only or Medicare-only beneficiaries, yet little is known about their behavioral health service utilization.</p> Objective <p>To compare behavioral health (BH) service use among Medicaid-only, Medicare-only, and dually eligible beneficiaries.</p> Methods <p>We conducted a retrospective analysis using claims data. Individuals with a BH diagnosis were classified into mutually exclusive coverage cohorts: Medicaid-only, Medicare-only, and dually eligible. Cohorts were further stratified into diagnostic groups: mental health (MH)-only, substance use disorder (SUD)-only, co-occurring MH/SUD.</p> Results <p>We identified 147,426,385 individuals enrolled in Medicaid and/or Medicare. 8.7% were dually eligible, 55.8% were Medicaid-only, and 35.5% were Medicare-only. Dually eligible beneficiaries had the highest prevalence of BH diagnoses. Dually eligible individuals had the highest rates of service utilization. Medicare-only beneficiaries had the lowest utilization rates. Medicaid-only beneficiaries showed intermediate levels of use. Within the dually eligible group, adults 18–54, males (for SUD), White beneficiaries, and urban residents had the highest utilization rates.</p> Conclusions <p>Dually eligible individuals exhibit higher BH service utilization, as compared to Medicaid-only and Medicare -only beneficiaries, suggesting elevated treatment needs.</p>

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A comparison of behavioral health service use among dually eligible, Medicaid-only, and Medicare-only beneficiaries

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月9日

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  • Mustafa Karakus,
  • Sushmita Shoma Ghose,
  • Cristian Ilie,
  • Peter Lee,
  • Amanda Harris,
  • N. Phil. Masiakowski,
  • Victoria Nelson,
  • Michael Ilie,
  • Howard Goldman,
  • Timothy B. Creedon

摘要

Background

Dually eligible individuals, enrolled in both Medicare and Medicaid, have complex medical, social, and behavioral health needs and account for a disproportionate share of spending in both programs. They experience higher rates of poverty, disability, chronic conditions, and behavioral health disorders than Medicaid-only or Medicare-only beneficiaries, yet little is known about their behavioral health service utilization.

Objective

To compare behavioral health (BH) service use among Medicaid-only, Medicare-only, and dually eligible beneficiaries.

Methods

We conducted a retrospective analysis using claims data. Individuals with a BH diagnosis were classified into mutually exclusive coverage cohorts: Medicaid-only, Medicare-only, and dually eligible. Cohorts were further stratified into diagnostic groups: mental health (MH)-only, substance use disorder (SUD)-only, co-occurring MH/SUD.

Results

We identified 147,426,385 individuals enrolled in Medicaid and/or Medicare. 8.7% were dually eligible, 55.8% were Medicaid-only, and 35.5% were Medicare-only. Dually eligible beneficiaries had the highest prevalence of BH diagnoses. Dually eligible individuals had the highest rates of service utilization. Medicare-only beneficiaries had the lowest utilization rates. Medicaid-only beneficiaries showed intermediate levels of use. Within the dually eligible group, adults 18–54, males (for SUD), White beneficiaries, and urban residents had the highest utilization rates.

Conclusions

Dually eligible individuals exhibit higher BH service utilization, as compared to Medicaid-only and Medicare -only beneficiaries, suggesting elevated treatment needs.