Projecting State Medicaid Savings from Enhanced D-SNP Integration
Greater integration between Medicare and Medicaid may help states improve care coordination, reduce fragmentation, and lower costs for dual eligible individuals with complex physical health, behavioral health, and long-term care needs. Integrated models may also reduce duplicative spending and shift care toward more appropriate, lower-cost settings.
Dual eligible beneficiaries are eligible for both Medicare and Medicaid benefits. Historically, they have had to separately navigate Traditional Medicare or Medicare Advantage plus Medicaid managed care or fee-for-service coverage. Recently, policymakers have been advancing integrated models, such as Dual Eligible Special Needs Plans (D-SNPs), that range from aligning enrollment under a single parent company to integrating all benefits in one plan.
The Elevance Health Public Policy Institute commissioned an external consultant to develop a model to estimate potential Medicaid fiscal impacts of integration strategies. The model applies an evidence-based framework to project how greater integration may impact healthcare utilization and spending. Methodological details are in the Methods Guide. The state-specific briefs estimate savings across varying integration scenarios.
Related Public Policy Research
Improving Integration in Dual Eligible Special Needs Plans
Efforts to improve care for dual eligible beneficiaries have increasingly focused on integrating Medicare and Medicaid through Dual Eligible Special Needs Plans (D-SNPs). This paper explores the benefits of greater integration and opportunities for states to improve care coordination, beneficiary experience, and health outcomes.
Medicare Advantage Supplemental Benefits Address Health-Related Social Needs
Medicare Advantage (MA) plans offer additional benefits not covered by traditional Medicare known as supplemental benefits. This paper examines the use of supplemental benefits overall and by demographic characteristics of MA members, demonstrating that supplemental benefits can address health-related 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.