Integrating Care through Dual Eligible Special Needs Plans (D-SNPs): Opportunities and Challenges

04/08/2019

The 11 million individuals dually-eligible for Medicare and Medicaid are among the highest need populations in either program. However, a lack of coordination between the Medicare and Medicaid programs makes it difficult for individuals enrolled in both to navigate these fragmented systems of care and adds to the cost of both programs. Special Needs Plans (SNPs), created by Congress in 2003, are a type of Medicare Advantage (MA) plan that limits membership to people with specific diseases or characteristics. Dual Eligible Special Needs Plans (D SNPs), one type of SNP, enroll only individuals dual-eligible for Medicare and Medicaid. As of 2013, all D SNPs must have contracts with the applicable state Medicaid program that contains a description of how the plan will provide and coordinate Medicare and Medicaid-financed care.

Although states' D SNP contracts can help to promote integrated care for dual-eligible beneficiaries, these plans face administrative and operational challenges in overcoming Medicare-Medicaid misalignment. In the last few years, several states, health plans, and the federal government have increased their efforts to overcome misalignments in Medicare and Medicaid to address some of the challenges that hindered D SNPs from more effectively coordinating care for dual-eligible beneficiaries. This issue brief highlights lessons learned from the experience of states that have used SNPs to integrate for duals and identifies a menu of administrative flexibilities under existing SNP authority to improve access to integrated services and care coordination for duals.

This report was prepared under contract #HHSP23320100021WI between the U.S. Department of Health and Human Services (HHS), Office of Disability, Aging and Long-Term Care Policy (DALTCP) and the Research Triangle Institute. For additional information about this subject, you can visit the DALTCP home page at http://aspe.hhs.gov/office-disability-aging-and-long-term-care-policy-daltcp or contact the ASPE Project Officer, Jhamirah Howard, at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201; Jhamirah.Howard@hhs.gov.

DISCLAIMER: The opinions and views expressed in this report are those of the authors. They do not reflect the views of the Department of Health and Human Services, the contractor or any other funding organization. This report was completed and submitted in November 2017.

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