Coordinating care for dual eligibles: options for linking state Medicaid programs with Medicare Advantage Special Needs Plans

Abstract

Medicare Advantage Special Needs Plans (SNPs) for dual eligibles--individuals who qualify both for Medicare and Medicaid benefits--have the potential to coordinate Medicare benefits with state-administered Medicaid benefits. States that aim to develop such programs may choose from among three potential models: 1) a Medicaid program in which the beneficiary voluntarily enrolls in a single managed care organization (MCO) that delivers both Medicaid and Medicare services; 2) a program in which the beneficiary is required to enroll in a Medicaid MCO but retains freedom of choice regarding whether to enroll in a capitated Medicare plan; and 3) an administrative services organization approach,in which Medicaid retains a vendor to coordinate Medicaid services with the SNPsoperating in the state. The authors also provide guidance on contractual issues important to state Medicaid agencies, and they discuss environmental factors that influence the choice of models and the program's prospects for success.