Medicaid Spending in Coordination-Only Dual-Eligible Special Needs Plans

Area of Science:

• Health Services Research
• Public Health Policy
• Gerontology

Background:

• Over 4 million Medicare beneficiaries are enrolled in dual-eligible Special Needs Plans (D-SNPs).
• Coordination-only D-SNPs are common, but their impact on Medicaid services and spending, particularly long-term services and supports (LTSS), is not well understood.
• Medicaid is the primary payer for LTSS, making D-SNP effects on these services critical to evaluate.

Purpose of the Study:

• To assess changes in Medicaid fee-for-service (FFS) spending before and after enrollment in coordination-only D-SNPs compared to non-D-SNP Medicare Advantage (MA) plans.
• To analyze the impact on various Medicaid-covered services, including LTSS, for community-living dual-eligible beneficiaries.
• To inform policy regarding D-SNP integration and its effects on vulnerable populations.

Main Methods:

• A cohort study using a new-user, active comparator design with inverse probability of treatment weighting.
• Inclusion of community-living dual-eligible beneficiaries in North Carolina with prior Medicare FFS enrollment.
• Analysis of linked Medicare and North Carolina Medicaid claims data from 2014-2017 to compare spending patterns pre- and post-MA enrollment.

Main Results:

• No significant differences in overall Medicaid FFS spending per person-year were observed between the D-SNP and other MA plan groups post-enrollment.
• A significant increase in spending on community-based personal care services (a component of LTSS) was noted in the D-SNP group compared to the other MA group.
• This maintained spending on LTSS in the D-SNP cohort, contrasting with reductions observed in the comparator group.

Conclusions:

• Coordination-only D-SNPs were associated with maintained Medicaid FFS spending on LTSS, specifically community-based personal care services.
• Despite this maintenance, current levels of integration in coordination-only D-SNPs may be insufficient to significantly reduce or delay nursing home transitions.
• Further investigation into higher integration models within D-SNPs is warranted to optimize LTSS delivery and outcomes for dual-eligible individuals.