The Mongan Institute, Massachusetts General Hospital, Boston.
Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
JAMA Netw Open. 2024 Sep 3;7(9):e2433972. doi: 10.1001/jamanetworkopen.2024.33972.
Since 2019 and 2020, Medicare Advantage (MA) plans have been able to offer supplemental benefits that address long-term services and supports (LTSS) and social determinants of health (SDOH).
To examine the temporal trends and geographic variation in enrollment in MA plans offering LTSS and SDOH benefits.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used publicly available data to examine changes in beneficiary enrollment and plan offerings of LTSS and SDOH benefits from the benefits data from the second quarter of each year and other data from April of each year except 2024, for which the first quarter was the latest for benefits data and January the latest for other data at the time of analysis. Multivariable linear regression models for each type of benefit were used to investigate associations between county characteristics and enrollment in 2024. Analyses were stratified for (1) Dual Eligible Special Needs Plans (D-SNPs) that exclusively enroll dual-eligible beneficiaries and (2) non-D-SNPs.
The percentage of MA enrollees in plans offering LTSS or SDOH benefits at the county level.
This study included 2 631 697 D-SNP and 20 114 506 non-D-SNP enrollees in 2020, which increased to 5 494 426 and 25 561 455, respectively, in 2024. From 2020 to 2024, the percentage of D-SNP enrollees in plans offering SDOH benefits increased from 9% to 46%, whereas the percentage fluctuated between 23% and 39% for LTSS benefits. There was an increase in non-D-SNP enrollees with LTSS (from 9% to 22%) and SDOH (from 4% to 20%) benefits from 2020 to 2023, which decreased in 2024. In 2024, the most offered LTSS benefit was in-home support services, and the most offered SDOH benefit was food and produce. The percentage of enrollees with these benefits varied across counties in 2024. In multivariable linear regression models, among D-SNPs, enrollment in plans offering any SDOH benefits was higher in counties with greater MA penetration (coefficient, 5.0 percentage points [pp] per 10-pp change; 95% CI, 2.1-7.9 pp), in urban counties (coefficient, 7.2 pp vs rural counties; 95% CI, 3.8-10.6 pp), in counties with greater enrollment in fully integrated D-SNPs (coefficient, 3.0 pp per 10-pp change; 95% CI, 2.2-3.9 pp), and in counties in states with approved Medicaid home- and community-based services waivers for individuals 65 years or older or those with disabilities (coefficient, 10.8 pp; 95% CI, 4.0-17.6 pp). Enrollment in D-SNPs offering LTSS benefits was also higher in counties with greater MA penetration (coefficient, 5.9 pp per 10-pp change; 95% CI, 2.4-9.5 pp), urban vs rural counties (coefficient, 4.6 pp; 95% CI, 1.1-8.1 pp), and counties with greater enrollment in fully integrated D-SNPs (coefficient, 3.0 pp per 10-pp change; 95% CI, 2.1-3.9 pp) in addition to counties with greater social vulnerability scores (coefficient, 1.4 pp per 10-pp change; 95% CI, 0.3-2.5 pp).
In this cross-sectional study of MA plans and enrollees, an increase in enrollment was most consistent in D-SNPs offering SDOH benefits compared with LTSS benefits and in D-SNPs compared with non-D-SNPs. Geographic variation in enrollment patterns highlights potential gaps in access to LTSS and SDOH benefits for rural MA beneficiaries and dual-eligible enrollees living in counties with lower enrollment in fully integrated D-SNPs and states with more limited Medicaid home- and community-based services coverage.
自 2019 年和 2020 年以来，医疗保险优势计划（MA）能够提供补充福利，以解决长期服务和支持（LTSS）以及健康的社会决定因素（SDOH）问题。
研究 MA 计划中提供 LTSS 和 SDOH 福利的参保情况的时间趋势和地域差异。
设计、设置和参与者：这项横断面研究使用公开可用的数据，从每年第二季度的福利数据和每年 4 月的其他数据（2024 年除外，当时福利数据的最新数据是第一季度，其他数据的最新数据是 1 月）来检查受益人的参保情况和 LTSS 和 SDOH 福利计划的变化。使用多变量线性回归模型来研究每个类型的福利与 2024 年县特征之间的关联。分析分为（1）仅招收双重合格受益人的双重合格特殊需要计划（D-SNP）和（2）非 D-SNP。
在县一级，MA 参保者中参加 LTSS 或 SDOH 福利计划的百分比。
这项研究包括 2631697 名 D-SNP 和 20114506 名非 D-SNP 参保者，分别增加到 2024 年的 5494426 名和 25561455 名。从 2020 年到 2024 年，D-SNP 参保者中参加 SDOH 福利计划的比例从 9%增加到 46%，而 LTSS 福利计划的比例在 23%到 39%之间波动。非 D-SNP 参保者中，LTSS（从 9%到 22%）和 SDOH（从 4%到 20%）福利的参保人数从 2020 年到 2023 年有所增加，但在 2024 年有所减少。2024 年，提供的 LTSS 福利中最常见的是家庭支持服务，提供的 SDOH 福利中最常见的是食品和农产品。2024 年，这些福利在县一级的参保人数有所不同。在多变量线性回归模型中，在 D-SNP 中，参加任何 SDOH 福利计划的参保人数在 MA 渗透率较高的县（系数，每增加 10 个百分点增加 5.0 个百分点[pp]；95%CI，2.1-7.9 pp）、城市县（系数，7.2 pp 比农村县；95%CI，3.8-10.6 pp）、完全整合的 D-SNP 参保人数较多的县（系数，每增加 10 个百分点增加 3.0 个百分点[pp]；95%CI，2.2-3.9 pp）以及批准了医疗补助居家和社区服务豁免的州（系数，10.8 pp；95%CI，4.0-17.6 pp）中更高。D-SNP 参保者参加 LTSS 福利的人数也更高在 MA 渗透率较高的县（系数，每增加 10 个百分点增加 5.9 个百分点[pp]；95%CI，2.4-9.5 pp）、城市县（系数，4.6 pp；95%CI，1.1-8.1 pp）以及完全整合的 D-SNP 参保人数较多的县（系数，每增加 10 个百分点增加 3.0 个百分点[pp]；95%CI，2.1-3.9 pp）以及社会脆弱性评分较高的县（系数，每增加 10 个百分点增加 1.4 个百分点[pp]；95%CI，0.3-2.5 pp）。
在这项对 MA 计划和参保者的横断面研究中，与 LTSS 福利相比，D-SNP 提供的 SDOH 福利的参保人数增加最为明显，与非 D-SNP 相比，D-SNP 的参保人数增加也更为明显。参保模式的地域差异突出了农村 MA 受益人和居住在完全整合的 D-SNP 参保人数较低和医疗补助居家和社区服务覆盖范围较窄的州的双重合格参保者获得 LTSS 和 SDOH 福利的潜在差距。
