HHS - Dual Eligible Beneficiaries in C-SNPs and I-SNPs - MRAS

On behalf of the Department of Health and Human Services (HHS), the U.S. General Services Administration (GSA) is conducting market research to explore capabilities related to providing support for dually eligible beneficiaries enrolled in various Medicare Advantage plans. The primary focus is on understanding how different plan types, specifically Dual Eligible Special Needs Plans (D-SNPs), Chronic Condition Special Needs Plans (C-SNPs), and Institutional Special Needs Plans (I-SNPs), impact the quality of care and outcomes for individuals who are eligible for both Medicare and Medicaid. This initiative aims to gather insights that will inform policies promoting integrated care for dually eligible individuals, ensuring high-quality care across all plan types.

The study seeks to compare quality outcomes among full-benefit dually eligible individuals enrolled in C-SNPs and I-SNPs with those enrolled in D-SNPs and non-special needs Medicare Advantage plans. By leveraging Medicare and Medicaid administrative data, the research will analyze differences in healthcare use and health outcomes across these plan types. The ultimate goal is to understand whether beneficiaries in plans that do not integrate Medicare-Medicaid benefits but have special needs-oriented designs experience differing levels of care quality compared to those in fully integrated D-SNPs.

Dually eligible individuals often face complex healthcare needs due to multiple chronic conditions, making seamless coordination between Medicare and Medicaid crucial. Despite efforts by the Centers for Medicare & Medicaid Services (CMS) to enhance integration through D-SNPs, a significant number of beneficiaries continue enrolling in C-SNPs and I-SNPs, which do not meet federal integration requirements. Understanding how these plans affect patient outcomes can guide future strategies aimed at improving service delivery, payment alignment, and administrative coordination between the two programs.

This market research effort underscores HHS's commitment to optimizing healthcare delivery for dually eligible populations by identifying gaps in current systems and exploring opportunities for enhanced integration across different plan types. Through this study, HHS aims to ensure that all dually eligible individuals receive consistent, high-quality care irrespective of their chosen health plan format.