Performance Improvement 2011-2012. What Types of Contracting are States Engaged in with Medicare Advantage Special Needs Plans? - Further Questions


The second report provides a more in-depth look at five contracts between Medicare Advantage SNPs and state Medicaid programs. The five featured programs were selected as examples of types of contracts currently being used by states and SNPs.

Existing state Medicaid contracts with SNPs raise important definitional questions about the dual SNP contracting mandate established under the Medicare Improvements for Patients and Providers Act of 2008. A dual SNP is often operated as a distinct product within a larger corporate entity. The corporate parent may or may not also operate a Medicaid managed care contract that includes duals. SNP-state contracts take a variety of approaches for providing incentives for coordination of care. Those that include long-term care services in the contract have explicit provisions for managing care as a single benefit. Those in which long-term care is not included contain a range of proposals for encouraging/requiring coordination between Medicare and Medicaid. Benefits included in SNP-state contracts range from a full slate of services (Medicare cost sharing, drugs, primary and acute care, long-term care, and behavioral health) to a minimum of Medicare cost-sharing responsibilities. Some SNP-state contracts explicitly obtain value-added services for beneficiaries.

Report Title: Medicaid Contracts with Medicare Special Needs Plans Reflect Diverse State Approaches to Dually Eligible Beneficiaries
Agency Sponsor: OASPE-ODALTCP, Office of Disability, Aging, and Long-Term Care Policy
Federal Contact: Hunter McKay, 202-690-6443
Performer: Thomson Reuters
Record ID: 9342 (Report issued June 18, 2010)

View full report


"PerformanceImprovement2011-2012.pdf" (pdf, 701.44Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®