People who are dually eligible for Medicare and Medicaid often have multiple chronic medical and behavioral health conditions and long-term care needs. This population of over 12 million individuals also has higher rates of social needs compared to non-dually eligible individuals. Unmet social needs can make it difficult for individuals to access care and follow care recommendations and medication regimens, resulting in avoidable hospitalizations and emergency department visits.
Recent federal flexibilities have enabled Medicare Advantage health plans, including Dual Eligible Special Needs Plans (D-SNPs), to offer Special Supplemental Benefits for the Chronically Ill to their members. These benefits could include housing supports, healthy food access, and transportation. However, the current funding mechanism for these benefits may not provide sufficient resources for health plans to meaningfully address the needs of their members.
With support from Arnold Ventures, the Association for Community Affiliated Plans (ACAP) partnered with CHCS to develop this report, which: (1) assesses gaps in the ability of D-SNPs to address their members’ social risk factors; and (2) explores policy options that would allow Medicare to provide D-SNPs the necessary tools to address social needs.