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

2. Key Information, Oregon
Oregon has roughly 50,000 “full duals”
56% 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 25% of Oregon’s duals’ costs are currently paid via capitation; 75% via FFS
Oregon 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 Oregon’s duals into coordinated care also makes market positioning critically important for MCOs interested in serving this subgroup

3. Estimated PMPM Cost, Oregon Full Duals, 2008
Age <65
Age 65+
All Full Duals
Average Eligibles
22,269
28,340
50,609
Total Medicaid Cost
$834
$1,313
$1,102
Nursing Home
$111
$624
$399
Capitated Care
$227
$168
$194
HCBS Waiver & Prosthetics
$409
$450
$432
Personal Support
$29
$22
$25
ICF/MR
$16 $8
$11
All Other Medicaid
$42
Estimated Medicare Costs
$796
$898
$853
Part A
$336
$288
Part B
$285
$373
$334
Part D
$284
$189
$231
Total Costs, Medicaid & Medicare
$1,630
$2,211
$1,956

4. Estimated Total Dollar Cost, Oregon Full Duals, 2008
Age <65
Age 65+
All Full Duals
Average Eligibles
22,269
28,340
50,609
Total Medicaid Cost
$222,772,069
$446,669,150
669,441,219
Nursing Home
$29,706,745
$212,361,268
242,068,013
Capitated Care
$60,696,810
$57,177,097
117,873,907
HCBS Waiver & Prosthetics
$109,194,681
$152,873,807
262,068,488
Personal Support
$7,699,914
$7,387,767
15,087,681
ICF/MR
$4,259,942
$2,668,288
6,928,230
All Other Medicaid
$11,213,977
$14,200,923
$25,414,900
Estimated Medicare Costs
$212,796,290
$305,367,589
$518,163,879
Part A
$60,682,666
$114,430,765
$175,113,430
Part B
$76,098,570
$126,803,268
$202,901,838
Part D
$76,015,054
$64,133,556
$140,148,610
Total Costs, Medicaid & Medicare
$435,568,359
$752,036,739
$1,187,605,098

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