SCAN Health Plan Expands Dual Eligible Special Needs Plan in CA

SCAN Health Plan is expanding its California Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) into San Diego County for 2023, increasing access to the state’s only FIDE-SNP.

SCAN Connections, a health maintenance organization (HMO) special needs plan, integrates Medicare and Medi-Cal—California’s state Medicaid program—into one health plan offered to dual eligible beneficiaries.

SCAN currently offers the FIDE-SNP in Los Angeles, Riverside, and San Bernardino Counties. Starting January 1, 2023, San Diego County residents will gain access to the plan.

“Not only is SCAN Connections California’s first FIDE SNP since launching in 2008, but we continue to be the only FIDE SNP in the state,” Sachin Jain, MD, president and chief executive officer of SCAN Group and SCAN Health Plan, said in the press release. “For more than 14 years we’ve been simplifying healthcare for our highest-needs members. We help navigate their benefits, coordinate their complex care needs and improve their health outcomes while keeping them home and out of nursing facilities.”

Almost one in five dual eligible beneficiaries live in California, the press release noted. In San Diego County alone, there are nearly 80,000 people who are dually eligible for Medicare and Medicaid.

Individuals enrolled in SCAN Connections have a 15 percent lower acute care utilization rate compared to high-need complex individuals who are not enrolled in a FIDE-SNP, according to Jain. In addition, 99 percent of members live in the community, not facilities, compared to 88 percent of Medicare beneficiaries.

SCAN Connections offers members zero-dollar copays for prescription drugs provided through the Value-Based Insurance Design (VBID program). The FIDE-SNP offers free access to virtual behavioral health services, $500 annually for vision services, and $175 quarterly for over-the-counter items.

Members also have access to dental coverage, transportation, and in-home caregiving services, and select chronically ill members receive $50 per quarter in food benefit cards.

The expansion into San Diego County comes soon after state and federal changes are set to impact dual eligible beneficiaries in California.

CMS is phasing out the dual eligible special needs look-alike plans, in which 12,000 dual eligibles in California are enrolled. The plans are ending on December 31, 2022. At the state level, the Cal MediConnect program is changing at the end of the year, and 230,000 members will be moved to a different plan type.

As California beneficiaries face the repercussions of these changes, SCAN Connections may be an alternative option for healthcare coverage.

“These industry changes put SCAN in a prime position to provide our integrated care model to more dual-eligible older adults,” said Eve Gelb, SCAN’s senior vice president of duals.

“Our successful results reflect our network of quality providers who are dedicated to serving this population. And every Connections member has access to a personal assistance team specially trained in the complexities of Medi-Cal and Medicare in order to help them navigate their robust benefits to full advantage.”

SCAN has expanded its Medicare Advantage footprint to reach more geographical areas and patient populations.

In August, the plan announced that it would offer Medicare Advantage plans in Texas for the first time in 2023. Residents in Harris and Bexar Counties in Texas and Nye County in Nevada will newly have access to SCAN’s Medicare Advantage offerings next year.

SCAN also recently launched a Medicare Advantage plan for older adults in the LGBTQ+ community to provide them with a non-discriminatory, quality healthcare experience. The payer partnered with a digital health platform to help connect this population to care management services, virtual care, and care navigation.