Advancing Integrated Care for Dually Eligible Individuals: Factors Influencing State D-SNP Contracting Decisions
To improve care for dually eligible individuals who qualify for both Medicare and Medicaid, the Centers for Medicare & Medicaid Services (CMS) has worked with states and health plans to develop programs that integrate Medicare and Medicaid benefits for this vulnerable population. A particularly popular method of achieving such integration is to use state Medicaid agency contracts with Dual Eligible Special Needs Plans (D-SNPs) to facilitate coordination and integration of benefits. In late 2020, with support from the Medicaid and CHIP Payment and Access Commission, Mathematica conducted a study of factors that influence state use of a variety of D-SNP contracting strategies to facilitate integration of Medicare and Medicaid benefits. Mathematica’s project report and issue brief summarize the study methods, contracting strategies examined, and key findings and conclusions from that study, including the importance of state context, resources, and capacity; challenges that states face in contracting with D-SNPs to cover rural areas; the importance of stakeholder engagement; and the need to consider potential trade-offs and the unintended consequences of particular strategies.