Promoting Integration in Dual-Eligible Special Needs Plans

December 2019

Managed care plans that integrate Medicare and Medicaid services have the potential to improve quality and reduce spending for dually eligible enrollees. Medicare Advantage (MA) dual-eligible special needs plans (D–SNPs) have the largest enrollment of any integrated plan type, but many of these plans have a low level of integration. This report provides an overview of the D-SNP and Medicaid managed care market, explains the unique benefits offered by D-SNPs, and identifies three underlying causes for low levels of integration: (1) the limited impact of enrollment in these plans among “partial-benefit” dual eligibles; (2) the limited number of D-SNPs that do not have capitated Medicaid contracts for long-term services and supports; and (3) misaligned enrollment where enrollees are enrolled in plans from separate managed care companies for Medicare and Medicaid services.

Policy changes to improve integration for D-SNP enrollees include new requirements to prohibit enrollment of partial-benefit dual eligible in D-SNPs, or to establish separate D-SNPs for this population. Aligned enrollment, which would require plan sponsors to offer companion Medicaid plans and could limit dual eligibles from enrolling in D-SNPs and Medicaid plans from separate companies, would also facilitate greater integration. Finally, this report addresses challenges related to D-SNP “look-alike” plans, which can undermine the overall integration of D-SNPs. These policy changes could reduce D-SNP enrollment in the short-term, but would lead to more integrated plans over time.

Posted to The Playbook on