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ASPE ISSUE BRIEF Steven Sheingold, Nguyen Nguyen, and Andre Chappel Disclaimer Persons with disabilities having problems accessing this document may call (202) 690-6870 for assistance.
Medicare Advantage (MA) is the current program under which beneficiaries can enroll in private health plans rather than having their care covered through Medicare's traditional fee for service (FFS) program. Payments to MA plans in many areas are now substantially greater than the cost of treating comparable beneficiaries in the traditional program.
This Brief reviews the history and current status of federal special needs plans (SNPs) authority, with particular attention to provisions of interest to state Medicaid programs that have or are considering entering into contracts with SNPs to integrate or coordinate Medicaid long-term care services with Medicare primary, acute and prescription drug services for dually eligible beneficiaries.
This Policy Brief helps fill an important gap in our understanding of medication patterns in long-term care facilities (LTCFs) by comparing use and spending for prescription and over-the-counter drugs during skilled nursing facility (SNF) stays and related non-qualifying long-term care facility episodes.