The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 authorized new types of Medicare Advantage programs called Special Needs Plans (SNPs) for “special needs individuals.” One type of SNP is Institutional Special Needs Plans (I-SNPs), which are intended for people who, for 90 days or more, need, or are expected to need, the level of care provided in a long-term care facility. As a type of Medicare Advantage plan, I-SNPs receive capitated payments from the Centers for Medicare & Medicaid Services that cover the cost of care in a skilled nursing facility (SNF) and hospitals, as well as physician visits and prescriptions drugs needed by I-SNP enrollees. To date there is no evidence that nursing home residents enrolled in I-SNPs are appropriately denied needed hospital care and actually receive additional clinical care in their nursing homes. More troubling is evidence from investigative reports that I-SNPs are gaming the Medicare reimbursement system for their own financial benefit by denying hospital care to nursing home residents who need it.
- Read the full Brief here.
April 2, 2026 – T. Edelman & M. Lambert