1. ACAP Dual Eligibles Toolkit: Summary Data for Maryland
Compiled by: Special Needs Consulting Services (SNCS)

2. Key Information, Maryland
Maryland has roughly 67,000 “full duals”
58% of these persons are age 65+
The full duals’ annual costs (across Medicaid and Medicare) now total approximately $300 billion – roughly $50,000 per person per year
53% of these expenditures are paid for by Medicaid
SNCS estimates that 4.8% of the Maryland’s duals’ costs are currently paid via capitation; 95.2% via FFS
Maryland plans to participate in CMS Capitation Alignment Demonstration, with initial enrollment effective January 2013
MCOs interested in serving duals under this demonstration need to engage in significant preparations during CY2012 (and CY2013)
Average lifetime revenue for each dual eligible enrolled is likely to approach or exceed $500,000, since most duals will remain eligible and enrolled for remainder of their lives (which should average > 10 years)
The high needs and high costs, coupled with the “rest of life” enrollment dynamic, creates profound and exciting care coordination opportunities
Moving Maryland’s duals into coordinated care also makes market positioning critically important for MCOs interested in serving this subgroup

3. Estimated PMPM Cost, Maryland Full Duals, 2008
Age <65
Age 65+
All Full Duals
Average Eligibles
27,390
38,983
66,372
Total Medicaid Cost
$1,915
$2,225
$2,097
Nursing Home
$312
$1,610
$1,074
Capitated Care
$74
$16
$40
HCBS Waiver & Prosthetics
$88
$44
$62
Personal Support
$160
$118
ICF/MR
$104
$15
$52
All Other Medicaid
$1,177
$453
$752
Estimated Medicare Costs
$1,307
$1,420
$1,373
Part A
$516
$581
$554
Part B
$426
$505
$472
Part D
$365
$334
$346
Total Costs, Medicaid & Medicare
$3,222
$3,645
$3,470

4. Estimated Total Dollar Cost, Maryland Full Duals, 2008
Age <65
Age 65+
All Full Duals
Average Eligibles
27,390
38,983
66,372
Total Medicaid Cost
$629,489,463
$1,040,862,599
$1,670,352,062
Nursing Home
$102,569,079
$753,032,705
$855,601,784
Capitated Care
$24,181,405
$7,448,068
$31,629,473
HCBS Waiver & Prosthetics
$28,924,016
$20,386,734
$49,310,750
Personal Support
$52,735,303
$41,041,499
$93,776,802
ICF/MR
$34,174,072
$7,111,022
$41,285,094
All Other Medicaid
$386,905,588
$211,842,571
$598,748,159
Estimated Medicare Costs
$429,643,079
$664,028,760
$1,093,671,839
Part A
$169,628,836
$271,819,655
$441,448,491
Part B
$140,176,896
$236,096,502
$376,273,398
Part D
$119,837,347
$156,112,603
$275,949,950
Total Costs, Medicaid & Medicare
$1,059,132,542
$1,704,891,359
$2,764,023,901

5. Publicly Available Resources Containing Data and/or Other Information About Maryland’s Dual Eligibles
Medicare-Medicaid Enrollee State Profile, Maryland, Centers for Medicare & Medicaid Services
Achieving Optimal Care Coordination for Medicaid/Medicare Dual Eligibles, August 2011, Special Needs Consulting Services (Joel Menges, Jeremy Batt, Kaleigh Beronja, Jessica Wiecezak)