Coordinating Care for Dual Eligibles: Options for Linking State Medicaid Programs with Medicare Advantage Special Needs Plans

Abstract

States that aim to develop Medicare Advantage Special Needs Plans for dual eligibles may choose from among three potential models discussed in this issue brief: 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 (ASO) approach, in which Medicaid retains a vendor to coordinate Medicaid services with the SNPs operating in the state. This issue brief also provides guidance on contractual issues important to state Medicaid agencies, and discusses environmental factors that influence the choice of models and the program’s prospects for success.