Dual Eligible Special Needs Plans (D-SNPs)

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).

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.

Promoting provider network alignment to improve integration in D-SNPs

Aligned Medicare and Medicaid provider networks can improve the care experience of D-SNP enrollees by eliminating the need to navigate separate Medicare and Medicaid provider networks to access care. During this ICRC state-only call, ICRC staff briefly described federal provider network adequacy requirements for D-SNPs.

Tips for States with Dual Eligible Special Needs Plans Affected by 42 CFR §422.514(h) Federal Regulations

In April 2024, CMS released new rules at 42 CFR §422.514(h) for D-SNPs with affiliated Medicaid managed care organizations (MCOs). This ICRC tip sheet provides (1) an overview of those new requirements, which take effect in 2027 and 2030, and a summary of rule exceptions, (2) illustrative examples and options for D-SNP compliance with each rule provision, and (3) action steps for states in working with D-SNPs to ensure compliance with these new rules.

Working with Medicare: State Contracting with D-SNPs – Part 2: Contracting Strategies and Considerations for States

This webinar builds on the foundational information presented in our last Working with Medicare webinar. It provides an overview of D-SNP contracting strategies and considerations for states with integrated D-SNPs. It is the second in a series of three webinars.

Working with Medicare: State Contracting with D-SNPs: Introduction to D-SNPs and D-SNP Contracting Basics

This webinar provides an overview of D-SNP contracting for state Medicaid agencies and a summary of new rules related to D-SNP contracting. It is the first in a series of three webinars. The second webinar in the series is available here, and the third is available here.

Working with Medicare: An Introduction to Dual Eligibility

June 10, 2025

This webinar will be especially helpful to state Medicaid agency staff who (1) are new to working with dually eligible individuals or (2) wish to better understand the different types of dual eligibility and the ways in which different groups of dually eligible individuals experience coverage and care.

Learning Objectives: By the end of this presentation, attendees should be able to:

Lessons Learned from Dual Eligible Special Needs Plans Enrollee Advisory Committee Strategic Conversation

This memorandum outlines lessons learned from a series of strategic conversations the Centers for Medicare & Medicaid Services held with Medicare Advantage organizations in December 2023 and January 2024 regarding calendar year 2023 implementation of Dual Eligible Special Needs Plan enrollee advisory committees.

Preventing and Addressing Unnecessary Medicaid Eligibility Churn Among Dually Eligible Individuals: Opportunities for States

People who are dually eligible for Medicare and Medicaid benefits often have multiple chronic physical and behavioral health conditions, and many use long-term services and supports (LTSS).1 Unfortunately, a relatively high proportion of dually eligible individuals cycle in and out of Medicaid eligibility, often due to lack of response to state Medicaid renewal notices. This creates disruptions in coverage and care, which can result in adverse health outcomes and increased costs for individuals and states.

D-SNP-Only Contracts: Benefits and Key Steps for States

This webinar describes the opportunity for states to require Dual Eligible Special Needs Plans (D-SNPs) that operate with exclusively aligned enrollment to establish contracts with the Centers for Medicare & Medicaid Services (CMS) that only include one or more D-SNPs within a state and integrate certain materials for enrollees.

Learning Objectives: By the end of this presentation, attendees should be able to: