Dual Eligible Special Needs Plans in California
Return to Integrated Care for Dual Eligible Beneficiaries
Dual Special Needs Plans (D-SNP) Contract and Policy Guide
Dual Eligible Special Needs Plans (D-SNPs) are Medicare Advantage (MA) plans that 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 DHCS and DHCS can choose whether to contract with D-SNPs.
Medi-Medi Plans
As part of CalAIM, DHCS promotes enrollment in health plans for dual eligible members, through an integrated Exclusively Aligned Enrollment (EAE) D-SNP model. Having Medicare and Medi-Cal benefits managed by the same organization promotes better care coordination and care experience for members.
In California, the general name
of these integrated plans are Medi-Medi Plans, and in 2024 and 2025 they are available in 12 counties. These plans
will be available in many additional counties in 2026. Medi-Medi plans provide care
coordination and integrated member materials, and have membership limited to
dually eligible individuals who are also enrolled in the Medi-Cal managed care
plan affiliated with the D-SNP.
DHCS Policy on D-SNPs without an affiliated Medi-Cal Plan
DHCS has two key policies regarding D-SNPs without an affiliated Medi-Cal managed care plan.
- Beginning in contract year 2024, and ongoing, DHCS will not sign a SMAC with a proposed new D-SNP in any county unless the D-SNP has an affiliated Medi-Cal plan. This policy to limit new D-SNPs is similar to policies in other states.
- For contract year 2025, and ongoing, in all counties, DHCS is limiting new enrollment in D-SNPs to only those D-SNPs that are affiliated with a Medi-Cal plan. This means that D-SNPs without an affiliated Medi-Cal plan will no longer be able to enroll new members, but existing members may remain with their plan.
These two policies are in accordance with state statute, and are intended to prepare for the expansion of Medi-Medi Plans in 2026.
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 on July 1, 2022.
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