The Commission is continuing its work on payment and access to care for individuals who are dually eligible for both Medicaid and Medicare. These beneficiaries are diverse and include individuals with multiple chronic conditions, physical disabilities, and cognitive impairments such as dementia, developmental disabilities, and mental illness as well as relatively healthy individuals. In 2022, dually eligible individuals accounted for only 13 percent of all Medicaid beneficiaries but 27 percent of total Medicaid spending.
Dually eligible individuals may be enrolled in a Medicare Advantage special needs plan (SNP) to receive their Medicare services and, depending on the type of plan, may also receive some or all their Medicaid services through a SNP. There are different types of SNPs: dual eligible special needs plans (D-SNPs), chronic condition special needs plans (C-SNPs), and institutional special needs plans (I-SNPs).
MACPAC staff presented findings from a literature and policy review of dually eligible individuals in SNPs and research on the recent increase in enrollment among C-SNPs, and to a lesser extent I-SNPs. This presentation provided background information on SNPs and enrollment of dually eligible individuals in these plans. MACPAC found increased dually eligible enrollment in C-SNPs and an increase in C-SNP availability. These findings coincide with the implementation of new requirements for D-SNPs, including D-SNP look-alike requirements.