​​​​​​​​​​​​​​​​​​​Dual Eligible Special Needs Plans in California

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​Dual Special Needs Plans (D-SNP) Contract and Policy Guide​​​​

Dual Eligible Special Needs Plans (D-SNPs) are Medicare Advantage (MA) health plans which provide specialized care and wrap-around services for dual eligible beneficiaries (eligible for both Medicare and ​Medicaid). D-SNPs must have a State Medicaid Agency Contract (SMAC) with the Department of Health Care Services (DHCS) and DHCS can choose whether to contract with D-SNPs.

Transition to Statewide MLTSS and D-SNP Structure under CalAIM

Under the California Advancing and Innovating Medi-Cal initiative (CalAIM), DHCS will transition Cal MediConnect (CMC) to an integrated Exclusively Aligned Enrollment (EAE) D-SNP program, managed by the same health plans that offered Cal MediConnect. Medicare Medi-Cal Plans (MMPs or Medi-Medi Plans) is the California-specific program name for EAE D-SNPs. The Medi-Medi plans will meet integrated D-SNP care coordination requirements, will have integrated member materials, and will have membership limited to dually eligible individuals who are also enrolled in the Medi-Cal managed care plan affiliated with the D-SNP. 

DHCS is convening the monthly public CalAIM MLTSS & Duals Integration Workgroup to work with stakeholders to support this transition. Information on how to register for the CalAIM MLTSS & Duals Integration Stakeholder Workgroup, and background materials from previous workgroup meetings is available here.

DHCS Policy on New D-SNPs and Service Areas​

As part of CalAIM, DHCS is implementing policies to promote integrated care for beneficiaries dually eligible for Medicare and Medi-Cal. Under this effort, for contract year 2023, DHCS will limit new Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) and expanded county service areas to only those D-SNPs with an ongoing affiliation with Medi-Cal managed care plans. This policy is based on the federal and state approach to having Medicare and Medi-Cal benefits for dually eligible beneficiaries managed by the same organization, to promote integrated care. Two separate health plans for Medicare and Medi-Cal benefits can lead to beneficiary and provider confusion, duplicate care managers, and more complexity for hospital and nursing home discharge planners. This policy to limit new D-SNPs is similar to policies in other states.

This approach in 2023 will not result in any members needing to disenroll from their existing Medicare plans. To avoid Medicare provider network disruption, DHCS will continue any existing D-SNP contracts and service areas, so that members in existing D-SNPs will not be required to disenroll.   

Having Medicare and Medi-Cal benefits managed by the same organization, as it is for MMPs, is an important component of CalAIM and aligns with the Department’s Managed Long Term Services and Supports (MLTSS) strategy. In 2023,  CalAIM policies will provide a more robust Medi-Cal managed care delivery system for dual eligible beneficiaries statewide, including mandatory Medi-Cal managed care enrollment statewide, Medi-Cal managed care carve-in of Skilled Nursing Facility care, Enhanced Care Management for populations needing Long Term Services and Supports, and Medi-Cal Community Supports provided by Medi-Cal plans.  

D-SNP Feasibility Study​

Pursuant to Welfare and Institutions Code, Section 14184.208(c)(5), DHCS conducted a feasibility study report of D-SNPs for Medi-Cal managed care plans (MCPs) in select non-Coordinated Care Initiative (non-CCI) counties. The feasibility study will help inform the transition under CalAIM to a statewide D-SNP structure for dual eligible beneficiaries and help DHCS establish processes and refine criteria for evaluating potential MCP requests for exemption from the D-SNP requirement. The D-SNP feasibility study was completed as of July 1, 2022, and can be found here: D-SNP Feasibility Study​​


Last modified date: 9/26/2022 4:30 PM