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Integrating Dual Eligible Special Needs Plan Materials to Promote Enrollee Understanding of and Access to Benefits

Integrating Dual Eligible Special Needs Plan Materials to Promote Enrollee Understanding of and Access to Benefits

Dual Eligible Special Needs Plans (D-SNPs) that operate with exclusively aligned enrollment and cover Medicaid benefits through the D-SNP or an affiliated Medicaid managed care plan – classified as applicable integrated plans (AIPs) – can provide their enrollees with a single set of fully integrated materials that describe both the Medicare and Medicaid benefits covered by the D-SNP (and its affiliated Medicaid plan, when applicable). 

This tip sheet was created to help states work with their AIP D-SNPs to develop integrated materials for D-SNP enrollees. The tip sheet: (1) explains why states should work with AIP D-SNPs to integrate D-SNP materials; (2) describes the specific materials that can be integrated and the benefits of integrating them; (3) summarizes key steps in developing integrated D-SNP materials; and (4) highlights key considerations for states interested in requiring D-SNPs to use integrated materials.
 

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Definitions of Different Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) Types in 2023 and 2025

This resource was updated in June 2023 to correct an error in the definition of applicable integrated plan in the previous version.

Dual Eligible Special Needs Plans (D-SNPs) must hold contracts with state Medicaid agencies, and states can use contractual requirements to better integrate and coordinate care for individuals who are dually eligible for Medicare and Medicaid. Federal rules issued in 2019 defined three different types of D-SNPs: “fully” integrated D-SNPs (FIDE SNPs); “highly” integrated D-SNPs (HIDE SNPs); and Coordination-only (CO) D-SNPs, and also defined “applicable integrated plans” (AIPs). New rules issued in May 2022 updated those definitions.

This tip sheet summarizes the updated definitions of FIDE SNPs, HIDE SNPs, CO D-SNPs, and AIPs for 2023 and compares the requirements for each D-SNP type. This information can be helpful to states as they develop and implement programs that advance Medicare-Medicaid integration for their dually eligible populations.

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Sample Language for State Medicaid Agency Contracts with Dual Eligible Special Needs Plans

To operate in a state, a Dual Eligible Special Needs Plan(D-SNP) must hold a contract with the state Medicaid agency. Those state Medicaid agency contracts (SMACs) must all have at least certain minimum elements, and states can also add additional requirements that aim to further coordination or integration of Medicare and Medicaid benefits for D-SNP enrollees. ICRC has developed four tools for states that provide sample contract language for the minimum required SMAC elements, as well as optional elements that states can add to SMACs with D-SNPs to further state goals related to care coordination, D-SNP enrollment, reporting and information sharing, and D-SNP materials. 

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