In March 2024, a bipartisan group of senators introduced the Delivering Unified Access to Lifesaving Services (DUALS) Act of 2024 to promote integrated care for individuals dually enrolled in Medicare and Medicaid. The DUALS Act would require and provide support to states to establish comprehensive, fully integrated plans for dual enrollees. The proposed legislation would also require all states to offer Program of All-Inclusive Care for the Elderly (PACE) services and expand eligibility for PACE. In this brief, we provide 10-year cost estimates for the DUALS Act, describing our methodological approach and key assumptions. We also discuss alternative scenarios, considering alternatives to our key modeling assumptions, possible modifications to the drafted legislation, and potential ways to offset the estimated cost of the legislation.

In our primary scenario, we estimate that federal spending on full dual enrollees would increase by $41.0 billion over the next decade under the DUALS Act relative to projected spending on full dual enrollees under current law. Just over half the projected spending ($21.4 billion) would come from additional spending associated with the new integrated plans themselves, primarily driven by the expected increase in spending on dual enrollees moving from traditional Medicare plans into the new integrated plans. Approximately 18 percent of the projected spending ($7.2 billion) would be attributable to growth in the number of full dual enrollees from a welcome mat effect, wherein Medicaid-eligible but unenrolled individuals would enroll in Medicaid as a result of the legislation. Another 18 percent ($7.2 billion) would come from PACE program expansions. Less than 10 percent ($3.7 billion) would come from a continuous eligibility provision, and $1.6 billion would come from other federal spending.

Ten years following enactment of the DUALS Act, we estimate that approximately one-quarter of all full dual enrollees would be enrolled in one of the new integrated plans and that the PACE program would enroll more than 100,000 additional full dual enrollees relative to expected growth in the PACE program under current law. We estimate nearly 30 percent of full dual enrollees would be enrolled in a fully integrated model by 2033, compared with less than 10 percent today.