Overview of Dual Eligible Special Needs Plans
A Dual Eligible Special Needs Plan (D-SNP) is an optional program within Medicare Advantage plans for individuals who are eligible for both Medicare and Medicaid coverage. This plan is designed to coordinate care among Medicare and Medicaid to improve care more effectively while also lowering costs. In addition to care coordination, D-SNPs can also offer supplemental benefits not typically available under Medicare but offered through Medicaid programs.
Nevada has over 94,000 Dual Eligible recipients. With such a large population of dual-eligible recipients with high utilizations of Medicaid services, there are opportunities to better coordinate care through a D-SNP program with the goal of improving quality of care and the addition of more services.
Eligibility for D-SNP
A person must be eligible and enrolled in Medicare Part A and/or Part B and receiving Medicaid benefits or Medicaid assistance with Medicare premiums or cost sharing. There are different types of dual-eligible recipients. A Full Benefit Dual Eligible (FBDE) and Qualified Medicare Beneficiary Plus (QMB+) has access to all Medicaid services and Medicaid also pays for the Medicare premiums, co-insurance, and deductible. For a Qualified Medicare Beneficiary (QMB), Medicaid only pays an individual's Medicare premiums, co-insurance and deductible amounts up to Medicaid allowable amounts.
Nevada has chosen these three dual eligible categories to participate in DSNP:
- Full Benefit Dual Eligible (FBDE)
- Qualified Medicare Beneficiary (QMB)
- Qualified Medicare Beneficiary Plus (QMB+)
Recipients who enroll in a D-SNP who are Full Dual Eligible DO NOT lose any existing Medicaid benefits for their current benefit plan such as Personal Care Services and Non-Emergency Transportation. Most dual health insurance plans also give more benefits than offered with traditional Medicare at no extra cost.
Nevada Medicaid has chosen to make the following eight (8) services available for eligible D-SNP recipients.
- Hearing Aids
- Non-emergency transportation to and from medical visits, including pharmacy
- Personal Emergency Response Systems (PERS)
- Nursing Hotline
- Meal Services after a hospital stay
If you have questions regarding your current benefit plan, please contact the Medicaid District office at (800) 992-0900. For more information on services, please refer to the Welcome to Nevada Medicaid booklet.
Nevada currently has a State Medicaid Agency Contract (SMAC) with eight (8) Medicare Advantage Plans. Each plan must provide the eight services listed above; however, there may be additional services offered to a D-SNP member as detailed on the right by each plan.
Upcoming D-SNP changes
Nevada is excited to announce it was recently awarded a grant through Arnold Venture to improve its D-SNP program and the integration of Medicaid and Medicare services for dual eligibles. Specifically, the Division will be contracting with a vendor, Mercer, to provide technical assistance to strengthen Nevada’s State Medicaid Agency Contract (SMAC). Specifically, the Division will be developing a strategy for procurement and contracting that promotes quality improvement and strengthens the state’s oversight of D-SNP plans.
Nevada Medicaid also plans to use the grant funding opportunity to analyze the current landscape and identify opportunities to support future program and policy planning related to the state’s efforts to advance integration of Medicaid and Medicare services for this population.
DHCFP will be posting more public information on this page soon regarding grant activities, including stakeholder engagement sessions. DHCFP welcomes feedback on areas to consider for future plan years. Below is an estimated timeline of events.
- Stakeholder engagement sessions- June through August of 2023
- Procurement Activities- January 2024 through December 2024
- Notification of Awardees- early January 2025 for Plan Year 2026
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