Forum Session

Medicare Advantage Special Needs Plans Reauthorization: What Should Congress Consider?
November 30, 2007


Christie Provost Peters


Medicare Advantage Special Needs Plans (SNPs) were created by Congress in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. These coordinated care plans are subject to all the same requirements as standard Medicare Advantage plans except (i) they must provide Part D benefits and (ii) they are authorized to limit their enrollment to targeted populations, namely beneficiaries dually eligible for Medicare and Medicaid; the institutionalized (or nursing home certifiable); and beneficiaries with severe or disabling chronic conditions. Designed to encourage greater access to Medicare Advantage (MA) plans for special needs individuals and to allow plans to tailor their benefits to meet unique needs, the SNP authority to limit enrollment has generated intense interest in the Medicare managed care market. The growth of the SNP market has far exceeded expectations. However, there are concerns that many plans are not experienced in working with special needs populations and that their benefit designs are not meaningfully different from standard MA plans. Many questions are being asked about SNPs, particularly about their added value, arrangements with states, and the extent to which truly integrated and specialized care is being delivered. In this Forum session, these questions and more were explored in an examination of the current SNP market, its effect on Medicare and beneficiaries, plan interactions with states, and possible changes for the future as Congress considers extending the SNP authority to limit enrollment.


Jim Verdier, JD, Senior Fellow, Mathematica Policy Research, Inc.; Abby L. Block, Director, Center for Beneficiary Choices, Centers for Medicare & Medicaid Services; Pamela J. Parker, Manager of Special Needs Purchasing, Purchasing and Service Delivery Division, Minnesota Department of Human Services; Robb A. Cohen, Chief Government Affairs Officer, XLHealth; Alissa E. Halperin, JD, Managing Attorney, Pennsylvania Health Law Project

Related Materials

See also a previous publication (Issue Brief No. 808, November 11, 2005) and Forum Session on this topic.

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