Proposals to raise the eligibility age for Medicare may have unintended consequences for state government finances. The medical care of persons who currently receive both Medicaid and Medicare benefits, also known as “dual eligibles,” could become the sole responsibility of Medicaid. In this brief we estimate the number of such individuals in each state and the amount of current Medicare spending that could be shifted to state Medicaid programs. The actual cost impact of such a policy change for an individual state depends on both the demographic makeup of its population and its decision about Medicaid expansion under the ACA.