The Medicare Payment Advisory Commission (MedPAC) devoted an hour and one-half to discussion about the proposals to integrate and coordinate care for individuals who are dually eligible for Medicaid and Medicare (Duals) that states are designing. Commission members expressed concern about automatic enrollment of Duals in managed care plans. The Commission Chair, Glenn Hackbarth, said that matching health plans with beneficiaries who have complex health needs will be critically important. The Centers for Medicare and Medicaid Services (CMS) has estimated that the demonstrations will enroll up to two million (20%) of the nation’s Duals. Another commissioner wondered where Duals who choose to opt out of managed care plans would go – would there be something to opt into. Commissioners also discussed the size of the demonstrations and wondered where comparison groups would be if a state plans to enroll all of its Duals in the demonstration. One commissioner thought that the proposals were more like Medicaid waivers than Medicare demonstrations. Although commissioners expressed unease about the demonstrations, they concluded the discussion by emphasizing the need to change the status quo which does not necessarily ensure quality care and is very costly.