Managed Care Shows Promise for Partial Duals as Population Grows
Managed care plans, particularly Dual Eligible Special Needs Plans (D-SNPs), are showing promise in improving health outcomes and reducing health care utilization among Medicare-eligible individuals who qualify as partial Medicare-Medicaid dual eligibles, according to a March 2023 study published by Elevance Health’s Public Policy Institute. Elevance’s analysis of 2020 CMS data found that 5% of the 65.9 million Medicaid eligibles that year were partial duals — those who are eligible for Medicare but are not yet enrolled in or do not qualify for the full range of Medicaid benefits in their state.
Meanwhile, the D-SNP population has grown considerably in recent years, from just over 2 million members in 2017 to 5.1 million members in 2023, according to AIS’s Directory of Health Plans (DHP). (Elevance, for its part, is the third-largest D-SNP insurer nationally, serving just over 600,000 members as of DHP’s March 2023 update). A handful of states also participate in CMS’s Financial Alignment Initiative for duals, enrolling their qualifying duals in Medicare-Medicaid plans (MMPs). And the vast majority of people enrolled in the Program of All-Inclusive Care for the Elderly (PACE) are dual eligibles.