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The American Rescue Plan Act is expected to infuse $11 billion in federal dollars to states to bolster home- and community-based services in Medicaid. But few states are connecting the dots on how integrated Medicare–Medicaid models for dually eligible individuals can support these efforts, according to a report from ATI Advisory

“There is significant overlap across the dually eligible population and those receiving varying degrees of supports in institutions, and individuals with dementia and cognitive impairments,” Brianna Ensslin Janoski, ATI Advisory director and lead author and analyst on the report, told McKnight’s Senior Living.

Integrated models, according to ATI, can support person-centered care by coordinating and maximizing HCBS. One way that some states are thinking about using the additional HCBS funding is to increase eligibility, such as raising the federal poverty level threshold, Janoski said. 

“In doing so, some assisted living / independent living residents may become dually eligible who aren’t currently eligible, increasing the likelihood of [dual-eligible special needs plans] serving more individuals in these settings, and creating a potential opportunity for more thoughtful D-SNP designs to support individuals in congregate settings,” she said.

The ATI report lays out information for policymakers to expand and improve the effect on the lives of HCBS beneficiaries.

“Specifically related to D-SNP state Medicaid agency contracts and memory care / dementia / congregate settings, states could do more to require that D-SNPs write into their models of care certain care management supports tailored to address the unique needs of this population, or build out their internal infrastructure to support individuals residing in congregate settings,” Janoski said.

Despite the promise of the model, only a fraction of the 42 states with D-SNP programs have tapped its potential, according to the report. 

Enrollment in D-SNPs has grown 80% over the past five years, bringing current enrollment to 3.6 million. The number of dually eligible individuals in Medicare and Medicaid increased 14% in that time, from 10.6 million to 12.3 million.

The federal policy environment affecting D-SNPs, according to the ATI report, has evolved considerably. While states work with CMS to refine and implement HCBS spending plans, they need to consider how to leverage their D-SNP programs to accomplish state rebalancing and other HCBS systems improvement goals, Janoski and the other authors wrote.

Next steps

Taking a little bit of effort to implement a few new requirements to contracts in the future will pay dividends down the road, they said.

“With the current focus on refinement and implementation of HCBS spending plans, states should use this time to evaluate opportunities to leverage D-SNPs and further integrate care for dually eligible beneficiaries to help achieve state goals and support community living,” the report reads. “States are missing an incredible and unprecedented opportunity to promote integration, and to leverage their D-SNPs to address HCBS spending plan goals.”