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Medicare Advantage Special Needs Plans for Dual Eligibles

Two issue briefs produced by The Hilltop Institute (as the Center for Health Program Development and Management) and published by the Commonwealth Fund examine Medicare Advantage Special Need Plans (SNPs) for persons who are eligible for both Medicare and Medicaid--Dual Eligibles. SNPs have the potential to improve the coordination of federal Medicare benefits and state-administered Medicaid benefits, thus enhancing the quality of care for dual eligibles. The issue briefs are co-authored by Hilltop's Executive Director Charles Milligan and Long-Term Supports and Services Director Cynthia Woodcock.

Medicare Advantage Special Needs Plans for Dual Eligibles: A Primer, February 25, 2008

The Special Needs Plan (SNP) is a new type of Medicare Advantage plan created by the Medicare Modernization Act of 2003 (MMA). The plans target one of three special needs populations, including dual eligibles. This issue brief identifies the key issues that underlie one of the MMA's central goals for dual-eligible SNPs—"the potential to offer the full array of Medicare and Medicaid benefits, and supplemental benefits, through a single plan"—and outlines their progress thus far. The brief observes that true coordination between SNPs and Medicaid programs, despite some state and federal initiatives, has largely failed to occur, and it discusses some of the reasons why. Consequently, the brief offers recommendations for improving dual-eligible SNPs' prospects and extending their lives (legal authorization for SNPs is scheduled to expire at year-end 2008).

Coordinating Care for Dual Eligibles: Options for Linking State Medicaid Programs with Medicare Advantage Special Needs Plans, February 25, 2008

States that aim to develop Medicare Advantage Special Needs Plans for dual eligibles may choose from among three potential models discussed in this issue brief: 1) a Medicaid program in which the beneficiary voluntarily enrolls in a single managed care organization (MCO) that delivers both Medicaid and Medicare services; 2) a program in which the beneficiary is required to enroll in a Medicaid MCO but retains freedom of choice regarding whether to enroll in a capitated Medicare plan; and 3) an administrative services organization (ASO) approach, in which Medicaid retains a vendor to coordinate Medicaid services with the SNPs operating in the state. This issue brief also provides guidance on contractual issues important to state Medicaid agencies, and discusses environmental factors that influence the choice of models and the program's prospects for success.