Tip Sheet

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).

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.

Success Begins with Selection: Tips on Assessing Bidders’ Past Performance for States Procuring Integrated Care Plans

This tip sheet is designed to help states that are planning procurements related to their integrated care programs for dually eligible individuals. It aims to help these states: (1) understand the relationship between state efforts to procure Medicaid managed care plans for these programs and the state’s D-SNP contracting strategy; (2) consider

Tips for States on Working with Dual Eligible Special Needs Plans to Improve Coordination of Physical and Behavioral Health Services for Dually Eligible Individuals

This tip sheet details strategies states can use in their State Medicaid Agency Contracts (SMACs) with Dual Eligible Special Needs Plans (D-SNPs) to promote integration and coordination of behavioral health benefits among enrolled dually eligible individuals. This tip sheet also highlights how a few D-SNPs have gone beyond the SMAC requirements to further promote behavioral health integration.

Tips for States on Incorporating D-SNPs into Medicaid Quality Improvement Activities

This tip sheet describes the Medicare resources available to states to monitor Dual Eligible Special Needs Plan (D-SNP) performance, explains how states can leverage those resources for Medicaid managed care quality oversight and improvement, and provides tips for states on incorporating D-SNPs into Medicaid quality improvement activities.

Tools for States on Exclusively Aligned Enrollment in Dual Eligible Special Needs Plans: Key Policy Decisions and Considerations for States Preparing for Exclusively Aligned Enrollment

This tip sheet summarizes four key policy decisions for states preparing to implement EAE, as well as four factors that states may wish to consider when making those policy decisions.

Tools for States on Exclusively Aligned Enrollment in Dual Eligible Special Needs Plans: Introduction to Exclusively Aligned Enrollment

This tip sheet provides a brief overview of exclusively aligned enrollment, as well as a summary of the benefits of EAE for dual eligible special needs plan (D-SNP) enrollees, providers, and states.

Tips to Help States Select Medicaid Managed Care Authorities as They Design Integrated Care Initiatives for Dually Eligible Individuals

This tip sheet summarizes key considerations for states trying to decide which pathway to use to advance Medicare-Medicaid integration, and which Medicaid managed care authority(ies) might best support that pathway. Although the tip sheet presents two pathways for states to consider, ultimately, a state may develop an integrated care model that falls somewhere in between these options. The Centers for Medicare & Medicaid Services (CMS) and ICRC can help each state identify a strategy that best meets its needs.

Dually Eligible Individuals: The Basics

ICRC has developed a basic fact sheet on individuals who are dually eligible for Medicare and Medicaid.

Tips to Improve Medicare-Medicaid Integration Using D-SNPs: Integrating Medicaid Managed Long-Term Services and Supports into D-SNP Models of Care

Dual Eligible Special Needs Plans (D-SNPs) must develop a model of care (MOC) that describes their enrollees’ characteristics and health and service needs as well as the plan’s care coordination and health risk assessment processes. Despite the importance of Medicaid services to dually eligible enrollees, D-SNPs are only required to describe Medicare services in their MOCs. However, states may require D-SNPs to develop an integrated MOC that describes not just how Medicare services will be provided, but also how the plan will provide and/or coordinate Medicaid benefits.