Start: October 2015
End: April 2017
Funder: U.S. DHHS, Office of the Assistant Secretary for Planning and Evaluation
Individuals dually eligible for Medicare and Medicaid are among the highest-cost enrollees in either program, but the lack of coordination between these two programs makes it difficult for them to get the care they need. Over the years, a variety of platforms have been created at the federal level to better integrate care for Medicare-Medicaid enrollees, including the Program of All-Inclusive Care for the Elderly (PACE) and the Financial Alignment Initiative, but these models do not necessarily work well for all states. Dual Eligible Special Needs Plans (D-SNPs), a special type of Medicare Advantage plan that serves only individuals enrolled in both Medicare and Medicaid, may be a more readily accessible platform for integrating Medicare and Medicaid.
In Advancing D-SNP-Based Policy Options for Medicare-Medicaid Enrollees, the Center for Health Care Strategies (CHCS) and its partner RTI International, identified policy options to promote Medicare-Medicaid integration using D-SNPs and assessed the challenges and considerations in implementing this model. CHCS gathered the experiences of states, health plans, providers, and other subject matter experts on the use of D-SNPs as an integration platform. This information was used to develop: (1) a list of administrative flexibilities that could be offered by the Department of Health and Human Services; and (2) options for states to improve integration and coordination of care under existing SNP authority. Findings will be disseminated nationally.