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More health care choice for Delawareans in need: Highmark Health options expands into dual special needs market

• Dual Special Needs Plans (D-SNP) cover individuals on Medicaid and Medicare

• More than 30,000 Delawareans are currently enrolled in D-SNP
• D-SNP coverage year for state’s largest Medicaid insurer begins Jan. 1, 2025

Wilmington, Del. (October 24, 2024) — Highmark Health Options, the state’s largest Medicaid managed care organization (MCO), is announcing new coverage options from Highmark Blue Cross Blue Shield (Highmark BCBS) that will soon be available to better serve Delawareans with complex health needs. Beginning Jan. 1, 2025, Highmark BCBS will offer Dual Special Needs Plans (D-SNP) for Delawareans who are eligible for both Medicaid and Medicare health care coverage. Highmark Health Options Duals (HMO SNP) plans are available during the current annual enrollment period, which runs until Dec. 7.

Dual Special Needs Plans are managed care health insurance plans specifically designed for individuals whose health needs require elevated levels of care. Individuals who benefit from D-SNP are often managing chronic conditions and comorbidities such as diabetes, high blood pressure, or mental and behavioral health. Dual Special Needs Plans help improve care coordination and health outcomes while managing cost.

Dual Special Needs Plans are closely aligned with long-term services and supports care (LTSS). Long-term services and supports includes both clinical and nonclinical care. Those who benefit from this type of care are people born with a disability, who develop a disability, or through the aging process are managing chronic conditions and comorbidities that can make everyday life more challenging. Highmark Health Options Delaware currently serves nearly 6,000 LTSS members.

“Our standing as the state’s largest Medicaid and long-term services and supports insurer make us uniquely positioned to assist our neighbors who need more support and attention to manage their health care needs,” said Todd Graham, president, Highmark Health Options. “The Dual Special Needs market demands innovative solutions and personalized care. We're committed to bringing our expertise and resources to this space to help address the specific challenges faced by individuals in need of these services.”

In addition to the Medicare and Medicaid requirement, highlights of D-SNP include:

• Enhanced Benefits – examples include transportation assistance and dental, vision and hearing services
• Care Coordination – can include disease management programs and dedicated case managers
• Community Collaboration – coordination with community organizations in the delivery of benefits

According to a 2021 report by the Medicaid and Children’s Health Insurance Program Payment and Access Commission, approximately 33,000 Delawareans were eligible for D-SNP enrollment at that time. Considering Delaware’s population growth of nearly 3% from 2021 through 2023, the number of eligible individuals is likely to have increased.