Key PointsQuestionFor Medicare beneficiaries with full Medicaid benefits, how does the use of Medicare and Medicaid services and spending by payer differ across need-based subgroups?FindingsThis cross-sectional study including 333 240 Medicare and Medicaid beneficiaries found that substantial use of Medicare- and Medicaid-funded services across all subgroups and describes the services contributing the most to total spending differed across subgroups. Medicaid-funded services, including community-based services and nursing home care, were key contributors to total spending among subgroups needing long-term care.MeaningThe diversity of health care use among dual-eligible beneficiaries requires integration strategies with comprehensive combined Medicare-Medicaid benefits to support whole-person, beneficiary-centered care for dual-eligible beneficiaries and their families.