Cuts driven by H.R. 1 are straining health systems, stretching providers thin, and widening the cracks in our health care system — making it harder for people to live full, independent lives. 

Thomas is a longtime Colorado resident who wears many hats: business owner, educator, mentor, and accessibility and youth advocate. An active member of his community, Thomas credits his ability to thrive to having both Medicaid and Medicare. 

12 million people people rely on both Medicare and Medicaid for health care

“Having mental health needs, especially having some physical aspects, and being neurodiverse as well… having both [Medicaid and Medicare] really means me taking care of me — being able to access the community resources that I need to live my best life.” 

Thomas is a white man with a beard and glasses. He is wearing a blue shirt and lanyard, holding a figurine at a Dungeons and Dragons workshop, smiling and looking down.

For Thomas, coverage isn’t abstract — it’s what allows him to show up for his community and maintain his independence. 

Why Dual Coverage Matters — and Where It Breaks Down 

Thomas is one of 12.8 million people who are dually eligible, relying on both Medicaid and Medicare for their health care. Dually eligible people often have complex health needs that require ongoing, coordinated care. Many are older adults and people with disabilities who live on low or fixed incomes, manage multiple chronic conditions, and rely on long-term supports for daily activities — from eating to managing medications. 

Having both [Medicaid and Medicare] really means me taking care of me — being able to access the community resources that I need to live my best life.
Thomas, Colorado

In theory, having both Medicaid and Medicare should mean more comprehensive care. In reality, it often means navigating two separate systems that don’t talk to each other. 

Thomas knows this firsthand. 

“I think the hardest thing has been trying to line up doctors… I had over a year where I couldn’t find a doctor or dentist who accepted my insurance. Luckily, I was able to find something — but it was a lot of hard work. And if I wasn’t so dedicated, I probably would have given up, at least for a while.” 

Because Medicare and Medicaid cover different services — and because provider information isn’t centralized — people like Thomas are left to figure out, on their own, which program covers what and who will accept it. Dental care is a clear example: Medicaid may cover it, Medicare generally does not, and finding accurate, up-to-date information can feel impossible. 

For many dually eligible people, managing care becomes a full-time job: coordinating providers, securing referrals, setting up releases, and chasing down communication between offices. 

“Even getting releases set up among my doctors can be an uphill battle… Sometimes it feels like: do I actually want to do this, or do I want to make sure everyone can communicate? Why is it taking so long?” 

What should be seamless instead becomes exhausting — and the burden falls on the very people the system is supposed to support. 

Integration Is the Missing Piece 

The problem isn’t that Medicaid and Medicare exist — it’s that they too often operate side by side instead of as one coordinated system. 

When coverage isn’t integrated: 

  • Care is fragmented 
  • Providers don’t communicate 
  • People delay or forgo care 
  • Health outcomes worsen 
  • Costs rise across the system 

And under H.R. 1, with fewer resources and greater strain on providers, these failures are becoming even more pronounced. 

But it doesn’t have to be this way. 

With the right policies, we can build a system where Medicaid and Medicare work together, so people like Thomas can focus on living — not navigating bureaucracy. 

What Needs to Change 

1. Guarantee Real Care Coordination for Every Dually Eligible Person 

Every plan serving dually eligible people should provide dedicated care coordination —with staff whose sole job is to help people navigate providers, benefits, and services across both programs. 

For Thomas, this could have meant help finding a dentist in weeks instead of a year. 

Care coordinators should: 

  • Help schedule appointments and referrals 
  • Ensure providers are communicating 
  • Support people through transitions in care 
  • Reduce the administrative burden on individuals 

This support is especially critical now, as providers face increased pressure under H.R. 1. 

2. Set Clear, National Standards for Care Coordination 

Congress should establish simple, enforceable national standards for what effective care coordination looks like across Medicaid and Medicare, including: 

  • Reasonable care coordinator-to-beneficiary ratios 
  • Requirements that providers share patient records across programs and points of care 
  • Clear expectations for handoffs between services (for example, hospital to home, primary care to specialists) 
  • Accountability through patient-reported experience and outcomes 

These standards should be built with input from people who rely on both programs — because no one understands the gaps better than those living with them. 

3. Make Integrated Plans Actually Work as One System 

Plans that are already successfully integrating Medicaid and Medicare should be uplifted and expanded into a single, unified system and be made available to all people who are dually eligible. 

That means: 

  • Stronger national standards for true integration 
  • Public reporting on outcomes specifically for dually eligible people 
  • Protections that allow people to keep their doctors and services — even when plans or programs change 
  • Clear accountability not just for plans, but for states responsible for oversight and enforcement 

Integration without accountability leaves people exposed when systems fail. 

4. Make Coverage Information Simple and Usable

People shouldn’t need to decode two programs to get care. 

Require integrated plans to provide: 

  • One benefits summary 
  • One provider directory 
  • One drug list 
  • One evidence of coverage 
  • One card for all services 

If Thomas had access to a single, accurate source of information, finding a dentist — or understanding which program covered which service — wouldn’t have taken a year of persistence. There are models already effectively bringing Medicaid and Medicare together that need to be singled out, uplifted and expanded for all. 

The Bottom Line 

Millions of people rely on both Medicaid and Medicare for their health, independence, and peace of mind. When these programs are fragmented, people pay the price. When they’re integrated, lives come together. 

Through sustained investment and smart policy, we can ensure dually eligible people get the coordinated, person-centered care they deserve — especially in the wake of H.R. 1. 

Your Story Can Help Drive Change 

If you or someone you love relies on Medicaid and Medicare, your voice matters. Share with us: How have having Medicaid and Medicare helped you live the life you want?

Record a short video sharing how these changes could affect your life — whether you’re a caregiver, an older adult, someone with a disability, or simply trying to stay healthy and housed. 

Your story can help show policymakers what’s really at stake — and why integrated care isn’t optional. It’s essential.