Individuals who are eligible for Medicare and Medicaid (“dual eligibles”) are among the highest-need and highest-cost participants in the U.S. health care system. Over the past five years, several states have attempted to develop programs to integrate and improve care for this population by taking advantage of the Medicare Modernization Act’s establishment of special needs plans (SNPs). To date, SNPs offer the most successful means to integrate care for dual eligibles. Even though the Patient Protection and Affordable Care Act is supporting new alternatives for integrated care, SNPs remain a viable opportunity for integration.
This CHCS technical assistance brief, made possible by The Commonwealth Fund, draws from the experiences of pioneering states to detail critical issues for state consideration in determining whether to contract with dual SNPs. It also lists key steps for states to pursue in designing SNP-based integrated care program, including:
- Engaging stakeholders;
- Developing the program design;
- Obtaining CMS approval; and
- Contracting with dual SNPs.
Although this brief focuses on achieving integration through SNPs, many of the considerations discussed can apply to the design of any integrated care model. States developing applications to participate in the Center for Medicare and Medicaid Innovation’s State Demonstrations to Integrate Care for Dual Eligible Individuals initiative may find this brief useful.