State Contracting with Medicare Advantage Dual Eligible Special Needs Plans: Issues and Options

Brief
Key Questions Answered
  • How can states effectively implement Dual Eligible Special Needs Plans (D-SNPs) contracts?
  • How can D-SNPs establish linkages with Medicaid managed long-term services and supports (MLTSS) programs?
Key Themes and Takeaways

D-SNPs are a type of Medicare Advantage plan that serve beneficiaries enrolled in both Medicare and Medicaid. This resource is a technical assistance tool based on an analysis of D-SNP contracts in 13 states, some of which link D-SNPs to Medicaid MLTSS programs.

  • To operate in a state, D-SNPs must have a contract with the state to facilitate coordination of Medicare and Medicaid services for enrollees.
  • States with the most extensive contracts with D-SNPs have well-established MLTSS programs, experienced D-SNPs that are interested in contracting with the state, and Medicaid agency leadership and staff who are knowledgeable about Medicaid and Medicare managed care.
  • As states consider what to include in their D-SNP contracts, they should consider the resources needed to design and implement integration requirements, review and analyze the information D-SNPs are required to submit to the state, and work with D-SNPs over time to refine and improve their integration programs.
Authors
James Verdier
Alexandra Kruse
Rebecca Sweetland Lester
Ann Mary Philip
Danielle Chelminsky
Population Addressed
Adults Under 65 with Disabilities
Frail Older Adults
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Level of Evidence
Non-systematic Review (without Evidence Grading)
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