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The more than 12 million Americans who are dually eligible for Medicare and Medicaid often have multiple chronic medical and behavioral health conditions, longterm care needs, and significant social determinant of health (SDOH) needs. Addressing their SDOH needs could help dually eligible individuals by improving access to and the effectiveness of their Medicare and Medicaid benefits, improving health outcomes and quality of life, and reducing health care costs.
Increasing recognition of the impact of non-medical factors on health and health outcomes led Congress and the Centers for Medicare & Medicaid Services (CMS) to create pathways for addressing Medicare beneficiaries’ non-medical needs. Recent CMS guidance described Special Supplemental Benefits for the Chronically Ill (SSBCI), which can include non-primarily health-related supplemental benefits (e.g., meals, food and produce, non-medical transportation, pest control, indoor air quality equipment and services, structural home modifications) that could address SDOH needs Beginning in 2020, Medicare Advantage plans could offer SSBCI to members with certain chronic conditions.
The Association for Community Affiliated Plans (ACAP) is a national trade association representing not-forprofit safety net health plans. ACAP has 24 Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) members that enroll mostly full-benefit dually eligible individuals. ACAP and its D-SNPs welcome the opportunity to provide SSBCI, but recognize that the current funding mechanism for those benefits (i.e., plans’ rebate dollars) may not provide sufficient resources to meaningfully address the needs of dually eligible members.
With support from Arnold Ventures, ACAP partnered with the Centers for Health Care Strategies (CHCS) to develop: (1) a Gap Analysis exploring D-SNP members’ SDOH needs, how the SSBCI pathway is being used, and whether the SSBCI pathway provides sufficient flexibility and resources to address SDOH needs; and (2) a set of Policy Options that explore alternative ways for Medicare to provide D-SNPs with tools to address SDOH. Both the gap analysis and the policy options were informed by interviews with ACAP D-SNPs and nationally recognized subject matter experts.