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Enrollment & timing

KFF Data: 12 Million Americans Hold Both Medicare and Medicaid, and Federal Medicaid Cuts Add Uncertainty to Their Extra Coverage

A new KFF brief profiles the roughly 12 million dual-eligible individuals who rely on both programs and account for a disproportionate share of combined spending, as provisions in the 2026 reconciliation law begin to reduce federal Medicaid funding.

By the Goodsurance editorial teamJuly 15, 2026

About 12 million Americans hold coverage under both Medicare and Medicaid and are known as dual-eligible individuals. A brief published by KFF in mid-July 2026 draws on linked Medicare and Medicaid administrative data to map this population's enrollment and spending patterns.

Dual-eligible individuals represent approximately 21 percent of total Medicare enrollment and about 13 percent of Medicaid enrollment. Despite making up a fraction of each program's total enrollees, they account for a significantly larger share of combined program spending because they tend to be older, have more chronic conditions, and need a wider range of services, including long-term care in nursing facilities and home and community-based settings.

Coverage arrangements for dual-eligible individuals vary by state. Many are enrolled in separate Medicare and Medicaid plans. A growing number belong to Dual Eligible Special Needs Plans, known as D-SNPs, which are Medicare Advantage plans designed to coordinate both programs' benefits under one insurer. D-SNP enrollment has grown rapidly in recent years.

The KFF analysis arrives as provisions in the reconciliation law enacted in 2026 are set to reduce federal Medicaid spending over the coming decade. KFF and other policy researchers have noted that state-level responses to reduced federal matching funds could affect dual-eligible individuals who rely on Medicaid for services not covered by Medicare, such as dental care, vision, hearing aids, and long-term supports and services. The extent of any impact will depend on how individual states choose to respond to the new federal funding structure.

In plain words

About 12 million people in the United States get health coverage from both Medicare and Medicaid. These people are called dual-eligible. They tend to be older and sicker than most Medicare enrollees, so both programs spend more on their care. Medicare pays for doctor visits and hospital stays. Medicaid often adds dental care, vision, hearing aids, and long-term care on top. A new federal law cuts how much money goes to Medicaid. If states reduce Medicaid benefits in response, some of the 12 million dual-eligible people could lose extra coverage they depend on.

Understand the basics first

Source: KFF
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