Changes in Care Associated with Integrating Medicare and Medicaid for Dual-Eligible Individuals

Eric T. Roberts
Lingshu Xue
John Lovelace
Chris Kypriotis
Kathryn L. Connor
Qingfeng Liang
David C. Grabowski
Peer-Reviewed Article
December 2023


Fully integrated dual-eligible special needs plans (FIDE-SNPs) are shown to increase use of home- and community-based services (HCBS), but have limited impact on inpatient and emergency department (ED) visits and length of nursing home stays.


Medicare Advantage FIDE-SNPs are specifically designed to cover Medicare benefits and Medicaid long-term services and supports (LTSS). Integrated care programs, like FIDE-SNPs, are recognized as important tools to support dually eligible individuals in navigating complex health care systems across Medicare and Medicaid coverage.

In 2018, Pennsylvania implemented Community HealthChoices (CHC), a mandatory Medicaid managed care program for older adults and people with disabilities. Under CHC, managed care plans were required to operate dual eligible special needs plans (D-SNPs) that were subsequently designated as FIDE-SNPs. The policy change presented an opportunity for the study’s authors to assess the impact of FIDE-SNP enrollment on individuals’ use of HCBS, access to care management and coordination, inpatient and ED visits, and long-term nursing home stays.


The authors analyzed the medical records of over 10,000 patients pre- and post-implementation of CHC and divided the individuals into a cohort of those enrolled in a FIDE-SNP and a comparison cohort of dually eligible individuals who remained enrolled in traditional Medicare during the same period. Enrollment in a FIDE-SNP was associated with an increase of 0.61 days in HCBS utilization per month per person. However, no statistically significant changes were observed in care management and coordination, inpatient and ED utilization, or long-term nursing home stays among those enrolled in FIDE-SNPs.


These findings are consistent with other research suggesting a positive association between integrated care programs and increased HCBS use. The authors also note that FIDE-SNP enrollees who used HCBS demonstrated a lower likelihood of qualifying for long-term nursing home care compared to the comparison cohort. This underscores the potential advantages of FIDE-SNPs in supporting individuals to receive care in community-based settings. However, the findings also highlight opportunities for improvement in how FIDE-SNPs manage care and a need for further assessment of their effectiveness.

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