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

2. Key Information, Texas Texas has roughly 350,000 “full duals”
67% 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 13.1% of Texas’ duals’ costs are currently paid via capitation; 86.9% via FFS
Texas 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 Texas’ duals into coordinated care also makes market positioning critically important for MCOs interested in serving this subgroup

3. Estimated PMPM Cost, Texas Full Duals, 2008
Age <65
Age 65+
All Full Duals
Average Eligibles
109,692
228,598
338,290
Total Medicaid Cost
$1,034
$924
$960
Nursing Home
$125
$472
$360
Capitated Care
$100
$88
$92
HCBS Waiver & Prosthetics
$329
$238
$267
Personal Support
$28
$53
$45
ICF/MR
$361
$25
$134
All Other Medicaid
$91
$49
$62
Estimated Medicare Costs
$1,119
$1,345
$1,272
Part A
$371
$496
$455
Part B
$465
$564
$532
Part D
$283
$286
$285
Total Costs, Medicaid & Medicare
$2,153
$2,269
$2,232

4. Estimated Total Dollar Cost, Texas Full Duals, 2008
Age <65
Age 65+
All Full Duals
Average Eligibles
109,692
228,598
338,290
Total Medicaid Cost
$1,361,020,316
$2,534,736,534
$3,895,756,850
Nursing Home
$164,423,742
$1,295,886,434
$1,460,310,176
Capitated Care
$131,346,783
$242,072,567
$373,419,350
HCBS Waiver & Prosthetics
$433,659,834
$651,608,427
$1,085,268,261
Personal Support
$36,763,523
$144,193,264
$180,956,787
ICF/MR
$474,959,904
$67,693,472
$542,653,376
All Other Medicaid
$119,866,530
$133,282,370
$253,148,900
Estimated Medicare Costs
$1,472,699,004
$3,690,342,791
$5,163,041,795
Part A
$488,955,947
$1,359,388,792
$1,848,344,739
Part B
$611,826,693
$1,546,614,589
$2,158,441,282
Part D
$371,916,365
$784,339,409
$1,156,255,774
Total Costs, Medicaid & Medicare
$2,833,719,320
$6,225,079,325
$9,058,798,645

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