Nationwide Availability of and Enrollment in Medicare and Medicaid Dual-Eligible Special Needs Plans With Exclusively Aligned Enrollment
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View abstract on PubMed
Summary
This summary is machine-generated.Availability and enrollment in dual-eligible special needs plans (D-SNPs) with exclusively aligned enrollment are growing, but remain low overall. Reforms are needed to increase aligned enrollment for beneficiaries.
Area Of Science
- Health Services Research
- Health Policy
- Gerontology
Background
- In 2021, a new category of dual-eligible special needs plans (D-SNPs) with exclusively aligned enrollment was introduced by the Centers for Medicare & Medicaid Services.
- Exclusively aligned enrollment means beneficiaries receive Medicare and Medicaid benefits through the same plan or affiliated plans within the same organization.
Purpose Of The Study
- To assess the availability and enrollment trends of D-SNPs with exclusively aligned enrollment.
- To compare characteristics of beneficiaries enrolled in available aligned D-SNPs versus those without such availability.
- To compare beneficiaries enrolled in aligned D-SNPs versus those in unaligned D-SNPs.
Main Methods
- Analysis of full-benefit beneficiaries enrolled in D-SNPs for at least 6 months in 2021 or 2022.
- Assessment of D-SNP availability and enrollment by county and year for aligned versus unaligned plans.
- Comparison of demographic, social, health, and area characteristics of enrollees based on plan availability and enrollment type.
Main Results
- In 2021 and 2022, 40.1% and 38.9% of D-SNP enrollees, respectively, lived in counties with aligned enrollment available, with 11.4% and 11.9% enrolled.
- Beneficiaries in counties without aligned D-SNPs were more likely to be rural, have disabilities, be Black, and live in areas with higher deprivation.
- Enrollees in aligned D-SNPs were more likely to receive long-term institutional care or have dementia/Alzheimer's disease.
Conclusions
- Availability and enrollment in exclusively aligned D-SNPs are increasing but remain low.
- Significant disparities exist in the characteristics of beneficiaries residing in areas with and without aligned D-SNPs.
- Further policy reforms are necessary to promote wider adoption of aligned enrollment options.
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