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Members Of D-SNPs Had Higher Levels Of Personal Care Services Compared To Other Medicare Advantage Members

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Dual-eligible Medicaid-Medicare beneficiaries newly enrolled in Medicare Advantage special needs plans for dual eligibles (D-SNPs) had higher use of Medicaid personal care services than dual eligibles enrolled in other Medicare Advantage plan types. Medicaid fee-for-service (FFS) spending on personal care services remained at the same level for those newly enrolled in a D-SNP, but declined for those newly enrolled in other Medicare Advantage plans. The relative spending increase was $343 per beneficiary enrolled in a D-SNP. Although the Medicaid personal care spending differed by Medicare Advantage plan type, there were no significant changes in total Medicaid spending. Any changes in total Medicaid spending for both groups could have been due to chance.

The change in Medicaid spending for personal care services was noted in an analysis of North Carolina Medicaid data for more than 13,000 dually eligible beneficiaries in the state who enrolled in a Medicare Advantage plan. The goal was to determine how enrollment in Medicare Advantage by plan type (D-SNP or another type) affected North Carolina Medicaid FFS spending for these individuals.

These findings were reported in “Medicaid Spending in Coordination-Only Dual-Eligible Special Needs Plans” by Neto Coulibaly, MS; Kelley A. Jones, Ph.D.; Valerie A. Smith, DrPH; and colleagues. The researchers compared how much the North Carolina Medicaid FFS program spent during the first year after dual-eligible beneficiaries enrolled in Medicare Advantage plans. For the comparison, they tracked state Medicaid spending for 8,869 beneficiaries who enrolled in a D-SNP that coordinated services with the state Medicaid program, and for 4,389 members of other Medicare Advantage plan types operating in the state. They sought to identify the impact of D-SNPs that coordinate with the state Medicaid program.

The researchers analyzed Medicare and North Carolina Medicaid claims data from 2014 to 2017 for each individual tracked. The analysis included data before and after enrollment in Medicare Advantage. The outcomes included annualized 1-year Medicaid FFS spending overall and by claim type, including inpatient, outpatient, carrier, home health, personal care services, and behavioral health services.

The full text of “Medicaid Spending in Coordination-Only Dual-Eligible Special Needs Plans” was published January 22, 2025, by JAMA Network Open. A free copy is available online at https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2829453 (accessed February 6, 2025).

OPEN MINDS last reported on this topic in “40% Of D-SNP Members Lived In A County With An Aligned Medicaid Managed Care Plan,” which published on October 30, 2024, at https://openminds.com/market-intelligence/news/40-of-d-snp-members-lived-in-a-county-with-an-aligned-medicaid-managed-care-plan/.

For more information, contact: Brystana G. Kaufman, Ph.D., Core Faculty Member, Duke-Margolis Institute for Health Policy and Assistant Professor in Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, North Carolina 27701; Email: brystana.kaufman@duke.edu; Website: https://populationhealth.duke.edu/profile/brystana-g-kaufman