Improving Integration in Dual Eligible Special Needs Plans
Greater integration of Medicare and Medicaid benefits through Dual Eligible Special Needs Plans (D-SNPs) can reduce fragmentation and improve care coordination, beneficiary experience, and health outcomes. As states adopt integrated models, they should prioritize aligned enrollment, stable plan options, enrollment in highly integrated models, and access to non-medical benefits.
Individuals who qualify for both Medicare and Medicaid are referred to as dual eligible beneficiaries. As a result of having to navigate two different benefit programs, they often experience fragmentation of care and worse outcomes. Dual eligible individuals also have significantly greater health challenges; for instance, 25 percent of dual eligible beneficiaries have six or more chronic conditions compared to 15 percent of non-dual eligible beneficiaries.
Historically, Medicare and Medicaid benefits were administered separately, but over the last two decades, efforts to better coordinate care for dual eligible beneficiaries have evolved significantly. States can further this move toward greater integration, with D-SNPs providing states with a flexible pathway to strengthen Medicare-Medicaid integration over time.
Related Public Policy Research
Dual Eligible Beneficiaries’ Grocery Supplemental Benefit Use and Health Care Utilization
Medicare Advantage plans can offer supplemental benefits that go beyond Traditional Medicare and can help enrollees meet social needs. This study found that use of a grocery card benefit among dual eligible enrollees was associated with increased office visits, including annual wellness visits.
Medicare Advantage Supplemental Benefits Are Associated with Improved Health Quality
The use of Medicare Advantage (MA) supplemental benefits—in particular, food and transportation benefits—is associated with improved healthcare quality, especially in managing diabetes and cardiovascular conditions. This analysis of dual eligible special needs plan enrollees highlights the importance of maintaining flexibility in offering non-medical benefits to support complex health and social needs.
Managed Care Models Improve Outcomes for Beneficiaries Who Are Partially Dual Eligible
Individuals who are eligible for partial dual status experience complex social and medical needs and could benefit from managed care or a tailored health plan, such as Dual Eligible Special Needs Plans (D-SNPs). This paper demonstrates that managed care has positive effects on health care utilization, including higher rates of primary care visits and lower rates of inpatient hospitalizations, readmissions, and skilled nursing facility stays, as compared to Traditional Medicare.