Dual-Eligible Nursing Home Residents: Enrollment Growth In Managed Care Plans That Coordinate Care, 2013-20

Abstract

Dual-eligible beneficiaries have insurance through two distinct and uncoordinated programs: Medicaid, which pays for long-term care; and Medicare, which pays for medical care, including hospital stays. Concern that this system leads to poor quality and inefficient care, particularly for dual-eligible nursing home residents, has led policy makers to test managed care plans that provide incentives for coordinating care across Medicare and Medicaid. We examined enrollment in three such plans among dual-eligible beneficiaries receiving long-term nursing home care. Two of those plans, Medicare-Medicaid plans and Fully Integrated Dual Eligible Special Needs Plans, are integrated care plans that establish a global budget including Medicare and Medicaid spending. The third, Institutional Special Needs Plans, puts insurers and nursing homes at risk for Medicare spending but not Medicaid spending. Among dual-eligible nursing home residents, enrollment in these plans increased from 6.5 percent of residents per month in 2013 to 16.9 percent in 2020. Enrollment varied across counties but did not vary appreciably with respect to nursing home characteristics, including the share of residents with Medicaid. As policy makers pursue strategies to coordinate medical and long-term care for dual-eligible beneficiaries, it remains critical to evaluate how these plans influence the care of dual-eligible nursing home residents.

Exhibit 2

Share of resident-months enrolled in each Medicare plan type among dual-eligible long-term nursing home residents, 2013-2020 Source: Authors’ analyses of the Medicare Beneficiary Summary File linked to the Minimum Data Set for the period 2013-2020. Abbreviations: SNP denotes Special Needs Plan, D-SNP denotes Dual Eligible Special Needs Plan, FIDE-SNP denotes Fully-Integrated Dual Eligible Special Needs Plan, and I-SNP denotes Institutional Special Needs Plan. Notes: Figure shows the share of resident-months with enrollment in each Medicare plan type by study year among dual-eligible long-term nursing home residents. Appendix Exhibit 1 shows the number resident-months of enrollment in each Medicare plan type. Appendix Exhibit 2 shows the share of resident-months with enrollment in each plan type using a balanced panel of nursing homes present in all study years.

Exhibit 3

County-level share of resident-months enrolled in managed care plans that coordinate Medicare and Medicaid, 2019-2020 Source: Authors’ analyses of the Medicare Beneficiary Summary File linked to the Minimum Data Set for the period 2013-2020. Note: Map shows the county-level share of nursing home resident-months with enrollment in managed care plans that coordinate care across Medicare and Medicaid (FIDE-SNPs, MMPs, and I-SNPs). Data are pooled from 2019 and 2020. Data are not reported for counties with fewer than 360 dual-eligible resident-months (indicated as ‘no data’ on the map). Appendix Exhibit 3 shows the county-level share of resident-months with enrollment in I-SNPs. Appendix Exhibit 6 compares state-level shares resident-months with enrollment in MMPs, FIDE-SNPs, and I-SNPs with enrollment in all other Medicare plan types.