Health Affairs Publishes Age-Friendly Health Paper in July Issue
An Age-Friendly Health series paper has been published in the July 2023 issue of Health Affairs.
The Age-Friendly Health series aims to inform health policies and covers new issues related to building more equitable, high-quality health systems for older adults.
Rapid Enrollment Growth In ‘Look-Alike’ Dual-Eligible Special Needs Plans: A Threat To Integrated Care by Yanlei Ma, Austin B. Frakt, Eric T. Roberts, Kenton J. Johnston, Jessica Phelan and José F. Figueroa
Dual-Eligible Special Needs Plans (D-SNPs) are types of Medicare Advantage plans that meet federal regulations to integrate coverage of Medicare and Medicaid for low-income older adults and others who qualify. Conventional Medicare Advantage plans that are marketed to the same dually-eligible population, known as "D-SNP look-alikes," may be a threat to integration as these plans are not subject to federal regulations requiring integrated Medicaid services.
The authors found that look-alike plans experienced rapid enrollment growth among dual eligible beneficiaries during the period 2013–20, increasing from 20,900 dual eligible beneficiaries across four states to 220,860 dual eligible beneficiaries across seventeen states, for an elevenfold increase.
The authors note that federal regulations were recently implemented to phase out look-alike plans with 80 percent dual-eligible enrollment or more, but their study suggests that the impact of this regulation may be limited because the number of plans below that threshold (but meeting the threshold of 50 percent dual-eligible enrollment) has grown. The authors write, "These findings suggest that look-alike plans may be potentially eroding national efforts to expand enrollment in integrated care programs that are responsible for coordinating coverage and care for dual-eligible beneficiaries and, importantly, underscore that further regulation of look-alike plans may be warranted."
Listen to a related podcast interview by Health Affairs' Editor-in-Chief Alan Weil with Yanlei Ma discussing dual-eligible SNPs.
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