Approximately 30 percent of the 13.6 million dually eligible Medicare and Medicaid beneficiaries in the US have serious mental illnesses (SMI), including schizophrenia, bipolar disorder, and major depressive disorder. While dual Medicare-Medicaid coverage has the potential to support access to comprehensive services to address these needs, fragmentation between the separately designed Medicare and Medicaid programs creates barriers to access and coordination.
Dually eligible beneficiaries with SMI can enroll in either the traditional fee-for-service Medicare program or the privatized Medicare Advantage (MA) program, in addition to Medicaid. Beneficiaries who choose MA can enroll in a special needs plan (SNP) catered to specific populations. Dual-eligible SNPs (D-SNPs) are designed to coordinate or integrate Medicare and Medicaid benefits, and these plans include highly integrated D-SNPs (HIDE-SNPs) and fully integrated D-SNPs (FIDE-SNPs).
The Centers for Medicare & Medicaid Services (CMS) recently introduced new rules to strengthen behavioral health integration requirements for these integrated D-SNPs. In a study in JAMA Network Open, Dr. Beth McGinty, chief of the Division of Health Policy and Economics and co-founding director of the Cornell Health Policy Center, Dr. Yongkang Zhang, assistant professor of population health sciences, and colleagues evaluated how enrollment and disenrollment in integrated D-SNPs and other Medicare options changed among dually eligible beneficiaries with SMI between 2019 and 2022, a time period capturing important policy changes in D-SNP integration.
The study found that during this time, enrollment in traditional Medicare among dually eligible beneficiaries with SMI and full Medicaid benefits decreased from 58.6 percent to 42.6 percent, while enrollment in MA increased from 41 percent to 57 percent. MA enrollment among dually eligible beneficiaries with SMI was driven by increased enrollment in integrated D-SNPs, particularly HIDE-SNPs. By 2022, 17.2 percent of all dually eligible beneficiaries with SMI were enrolled in an integrated D-SNP. Additionally, a higher proportion of dually eligible beneficiaries with SMI retained enrollment in integrated D-SNPs than in other Medicare options, suggesting satisfaction with these integrated plans.
Several policy changes likely contributed to increased enrollment in D-SNPs during this time, including the Bipartisan Budget Act of 2018, which permanently authorized D-SNPs, and CMS’ 2019 implementing rule, which strengthened integration requirements and introduced the HIDE-SNP designation. Researchers state that further investigation is needed to assess how D-SNP plans impact care access, quality, costs, and health outcomes.
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