To improve dual eligibles’ health, create targeted SDOH funds and increase integration

Dual Eligible Special Needs Plans (D-SNP) were established by Congress within Medicare Advantage to coordinate care more closely for people eligible for both Medicare and Medicaid. According to March 2020 data from the Centers for Medicare and Medicaid Services’ (CMS’s) Medicare-Medicaid Coordination Office, dual-eligible beneficiaries represent 20 percent of the Medicare population but make up 34 percent of Medicare spending. Similarly, they represent 15 percent of the Medicaid population but account for a third of Medicaid spending. The individuals served by D-SNPs continue to hold outsized importance to policy makers, payers, and clinicians because they require more care: They have more chronic conditions, disabilities, and complex care needs, including long-term services and supports (LTSS), and more expense than other beneficiaries. Successfully addressing dual eligibles’ health care challenges entails better integrating service delivery across Medicare and Medicaid to improve care coordination for—and the well-being of—the most complex beneficiaries. Achieving these objectives will contribute significantly to the United States’ longstanding goal of making care more equitable for dual eligibles.