Objective: The objective is to provide a statewide population-based comparison of Michigan beneficiaries dually eligible for Medicare and Medicaid (duals) to Medicare-only beneficiaries, including the public health expenditures by service type, and to focus on the LTC service use patterns of elderly duals receiving care in various settings. Data Sources: Data sources were linked 2005 and 2006 individual Medicaid and Medicare claims from all Michigan duals. Methods: CMS provided Medicare claims and beneficiary data. Michigan Department of Community Health provided Medicaid claims data. Design: We compared characteristics and health expenditures across various categories of beneficiaries and LTC care settings. Principal Findings: The 13% duals accounted for 33% of total Medicare and Medicaid expenditures. Eight percent of elderly beneficiaries were duals in 2005, accounting for 26% of public health expenditures in the aged. The average monthly expenditures of elderly duals were: $4,896 in institutional LTC, $2,921 for those served through HCBS waiver programs, and $1,488 for those in the community. Conclusions: Duals in Michigan account for a disproportionate large share of state and federal health expenditures. Michigan’s experience suggests that LTC services can be offered in home and community-based settings, at lower costs compared to institutional LTC. The shift in prescription drug coverage from Medicaid to Medicare increased the drug expenditures for some duals and had limited impact on overall dual expenditures. Results may be pertinent within the context of impending healthcare reforms.

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