Exclusively Aligned Enrollment

“Exclusively aligned enrollment” (EAE) occurs when a state limits D-SNP enrollment to full-benefit dually eligible individuals who receive their Medicaid benefits from the D-SNP or an affiliated Medicaid managed care plan offered by the same parent organization as the D-SNP. This requirement ensures that anyone who enrolls in the D-SNP is ultimately entitled to the same, unified package of benefits and facilitates several important benefits for plan enrollees, providers, and states. ICRC has compiled several resources for states to help states understand options for achieving EAE in a variety of state circumstances, relevant considerations and policy decisions, and key steps involved in implementing EAE.

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• Using Exclusively Aligned Enrollment to Integrate Medicare and Medicaid Benefits for Dually Eligible Individuals

  In this webinar, ICRC team members explain how exclusively aligned enrollment promotes integration of Medicare and Medicaid benefits for dually eligible individuals enrolled in Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs), describe three models that states can use to achieve exclusively aligned enrollment in D-SNPs, and outline key considerations and steps for states in designing and implementing exclusively aligned enrollment. (ICRC, June 2023)

• 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. (ICRC, June 2023)

• 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. (ICRC, June 2023)

• Implementing "Medicare-First" Exclusively Aligned Enrollment: Key Steps & Considerations for States 

  In this webinar, ICRC staff explain two approaches to implementing EAE—a “Medicare-first” approach and a “Medicaid-first” approach—and explain why a state might choose one approach or the other; summarize the Medicare Advantage enrollment process used by D-SNPs; identify the typical steps that states take to align Medicaid managed care enrollment with D-SNP enrollment when using a “Medicare-first” approach to EAE; and describe key policy decisions and file exchange options that states should consider before implementing Medicare-first EAE. (ICRC, June 2026)

• Key Steps and Considerations for States Using “Medicare-First” Exclusively Aligned Enrollment Processes with Dual Eligible Special Needs Plans (D-SNPs)

  This technical assistance brief outlines key steps and considerations for states implementing EAE using a "Medicare-first" approach (meaning the state matches a dually eligible individual's Medicaid enrollment to their choice of D-SNP enrollment). It provides an overview of the MA enrollment process, a summary of key steps in aligning Medicaid coverage with D-SNP enrollment; key decisions for states interested in using Medicare-first EAE, examples of common enrollment and disenrollment scenarios for states to consider when designing Medicare-first EAE processes; and descriptions of the files through which states can learn about D-SNP enrollments and disenrollments. (ICRC, June 2026)

• 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. (ICRC, March 2024)

• Monthly exclusively aligned enrollment report

  ICRC produces this report on a monthly basis using publicly available CMS data. It shows how many dually eligible individuals are enrolled in Medicare-Medicaid Plans (MMPs), Programs of All-Inclusive Care for the Elderly (PACE) and Applicable Integrated Plans (AIPs) by state and plan.