Assessing the Value of D-SNP Enrollment for Partial-Benefit Dually Eligible Individuals Who Switch to Full-Benefit Status
- Among all switchers in 2018, 7.3 percent used Medicare-covered skilled nursing facility (SNF) services in the month before the switch from partial-benefit dually eligible (PBDE) to full-benefit dually eligible (FBDE) status, 9.9 percent used hospital services in the month before the switch, and 10.5 percent had an emergency department (ED) visit in the month before the switch. Within the month of the switch through two months following the switch, 22.5 percent of switchers began using Medicaid-covered home- and community-based services (HCBS), and 14.1 percent began using institutional care. Results were similar in 2019, although the percentages were slightly lower for all service use except for HCBS use, which was similar over the two years.
- In regression models that adjusted for individual characteristics, PBDE Dual Eligible Special Needs Plan (D-SNP) enrollees’ use of Medicare-covered SNF and hospital services in the month before the switch to FBDE status was statistically significantly lower than that of PBDE individuals enrolled in regular Medicare Advantage (MA) plans and fee-for-service (FFS) Medicare.
- In regression models that adjusted for individual characteristics, PBDE D-SNP enrollees’ use of Medicaid-covered HCBS in the month of the switch through two months after the switch to FBDE status was statistically significantly higher than that of their counterparts enrolled in regular MA plans and FFS Medicare, and PBDE D-SNP enrollees’ use of Medicaid-covered institutional care in the month of the switch through two months after the switch was statistically significantly lower than that of their counterparts in regular MA plans and FFS Medicare. The differences in service use between individuals in different plan types were larger for institutional care than for HCBS.
- Rates of service use varied across subgroups of switchers (age groups, male versus female sex categories, racial and ethnic groups, original reason for Medicare entitlement [age, disability, or end-stage renal disease], and urban versus rural residence), but we found few notable differences from our main results across subgroups in the patterns of service use by Medicare coverage type.
This study sheds light on the extent to which enrollment in MA D-SNPs improves outcomes for PBDE individuals who become FBDE individuals. Among PBDE individuals who transitioned to FBDE status from 2018–2019, we found that relative to PBDE individuals with similar demographic characteristics and health status who were enrolled in FFS Medicare or regular (non–D-SNP) MA plans, those who were enrolled in D-SNPs had (1) lower rates of acute hospitalization and post-acute SNF use in the month before their switch to FBDE status and (2) greater use of HCBS and less use of institutional care in the month of the switch through two months after their switch to FBDE status. Our results do not account for other differences between PBDE enrollees in D-SNPs compared to those in other Medicare coverage types, such as functional status or other underlying factors that may precipitate a transition in Medicaid benefit status and affect health outcomes. Our results also are not generalizable to the broader PBDE population or to utilization over longer periods before or after the switch in dual eligibility status than those examined in this study. Despite these limitations, our results indicate that D-SNP enrollment may benefit the estimated 2.7 percent of all dually eligible individuals who switch from PBDE to FBDE status each year, particularly with respect to lower use of institutional care after they become eligible for full Medicaid benefits. Currently, some states do not allow PBDE individuals to enroll in D-SNPs, and researchers, policymakers and advocates have debated whether D-SNP enrollment provide any potential benefit for PBDE individuals. These findings provide some evidence that PBDE individuals who switch to FBDE status may benefit from care models like D-SNPs that provide additional care coordination, but those benefits should be further explored in future research and considered carefully alongside other relevant factors (for example, differences in functional status and behavioral health needs among those with different types of Medicare coverage; favorable selection and coding intensity for individuals in D-SNPs versus other coverage types; and length of follow-up periods after PBDE individuals become FBDEs) when states determine D-SNP enrollment options for PBDE populations.