State PACE AIPs CO D-SNPs HIDE SNPs FIDE SNPs Publicly Available SMAC
Alabama Yes No Yes No No No
Alaska No No No No No N/A
Arizona No Yes No Yes Yes Yes
Arkansas Yes No Yes No No No
California Yes Yes Yes No Yes Yes
Colorado Yes No Yes No No No
Connecticut No No Yes No No No
Delaware Yes Yes Yes* Yes No No
District of Columbia Yes Yes Yes* Yes No No
Florida Yes Yes Yes* Yes Yes Yes
Georgia No No Yes No No No
Hawaii No Yes No Yes Yes No
Idaho No Yes Yes* No Yes Yes
Illinois Yes Yes No No Yes Yes
Indiana Yes Yes Yes No Yes Yes
Iowa Yes No Yes Yes No No
Kansas Yes No Yes* Yes No No
Kentucky Yes No Yes* Yes No No
Louisiana Yes No Yes No No No
Maine No No Yes No No No
Maryland Yes No Yes No No No
Massachusetts Yes Yes No No Yes Yes
Michigan Yes Yes Yes Yes No Yes
Minnesota No Yes No Yes Yes Yes
Mississippi No No Yes No No No
Missouri Yes No Yes No No No
Montana No No Yes No No No
Nebraska Yes No Yes Yes No No
Nevada No No Yes No No No
New Hampshire No No No No No N/A
New Jersey Yes Yes No Yes Yes Yes
New Mexico Yes Yes Yes Yes No No
New York Yes Yes Yes Yes Yes Yes
North Carolina Yes No Yes No No No
North Dakota Yes No Yes No No Yes
Ohio Yes Yes Yes No Yes No
Oklahoma Yes No Yes No No No
Oregon Yes No Yes* Yes No No
Pennsylvania Yes No Yes Yes No Yes
Rhode Island Yes Yes Yes No Yes Yes
South Carolina Yes Yes Yes Yes No Yes
South Dakota No No Yes No No No
Tennessee Yes Yes Yes No Yes Yes
Texas Yes Yes Yes Yes Yes No
Utah No No Yes No No No
Vermont No No No No No N/A
Virginia Yes Yes Yes* Yes Yes Yes
Washington Yes No Yes Yes No Yes
West Virginia No No Yes No No No
Wisconsin Yes Yes Yes Yes Yes Yes
Wyoming No No Yes No No No

Notes:

* In Delaware, the District of Columbia, Florida, Idaho, Kansas, Kentucky, Oregon, and Virginia, CO D-SNPs only enroll partial-benefit dually eligible individuals.

  1. PACE information is from 2025.
  2. Links to SMACs are for the most recent SMAC published. This table includes SMACs from 2023 and later.
  3. Alaska, New Hampshire, and Vermont do not have any PACE organizations or D-SNPs. All other states that have a “No” in the CO D-SNP column have chosen to only contract with integrated D-SNPs.

Definitions

  • Program of All-Inclusive Care for the Elderly (PACE)– PACE provides comprehensive medical and social services to individuals age 55 and older who need a nursing facility level of care but reside in the community. PACE organizations provide all Medicare and Medicaid benefits for dually eligible enrollees, along with care coordination administered by an interdisciplinary care team.
  • Dual eligible special needs plan (D-SNP) – D-SNPs are Medicare Advantage plans that are designed for—and only enroll—people who are dually eligible for Medicare and Medicaid. For information about D-SNPs, including resources for state contracting with D-SNPs, see our D-SNP resource pages.
  • Coordination-only D-SNP (CO D-SNP) CO D-SNPs meet minimum CMS requirements for D-SNPs but do not qualify as a highly or fully integrated D-SNP. CO D-SNPs must (1) hold a contract with the state Medicaid agency in each state of operation that meets the requirements described at 42 CFR §422.107; (2) coordinate the delivery of Medicare and Medicaid services for its enrollees; and (3) meet the information-sharing requirements at 42 CFR §422.107(d).
  • Highly integrated D-SNP (HIDE SNP) – HIDE SNPs are D-SNPs that cover Medicaid behavioral health benefits, long-term services and supports, or both through a capitated contract with the state Medicaid agency that (1) covers the entire service area of the D-SNP and (2) is executed with the D-SNP, the D-SNP’s parent organization, or another entity owned and controlled by the D-SNP’s parent organization.
  • Fully integrated D-SNP (FIDE SNP) – FIDE SNPs are D-SNPs that provide coverage of Medicare and Medicaid benefits under a single legal entity that holds both: (1) an MA contract with CMS; and (2) a contract with the state Medicaid agency that meets the requirements of a managed care organization as defined in section 1903(m) of the Social Security Act. FIDE SNPs must operate with exclusively aligned enrollment and cover all of the following Medicaid benefits: primary and acute care services; Medicare cost sharing; behavioral health services; home health services; medical equipment, supplies and appliances; and long-term services and supports (including at least 180 days of nursing facility coverage during the plan year). Like HIDE SNPs, a FIDE SNP’s capitated contract with the state Medicaid agency (for coverage of the required Medicaid benefits) must cover the entire service area of the D-SNP. FIDE SNPs must also coordinate Medicare and Medicaid benefits “using aligned care management and specialty care network methods for high-risk beneficiaries” and employ “policies and procedures approved by CMS and the State to coordinate or integrate beneficiary communication materials, enrollment, communications, grievances and appeals, and quality improvement” (42 CFR §422.2).
  • Applicable integrated plan (AIP) – AIPs are D-SNPs that operate with exclusively aligned enrollment and cover at least certain Medicaid benefits (through the D-SNP or through an affiliated Medicaid managed care plan operated by the same parent organization as the D-SNP). AIPs must implement unified plan-level appeal and grievance processes that comply with the regulations at 42 CFR §§422.629 – 422.634. To qualify as an AIP, a D-SNP must be:
    • A FIDE SNP;
    • A HIDE SNP that operates with exclusively aligned enrollment; or
    • A CO D-SNP that operates with exclusively aligned enrollment and covers (through the D-SNP or an affiliated Medicaid managed care plan) Medicaid primary and acute care benefits, Medicare cost sharing, and at least one of the following additional Medicaid benefits: home health services; medical supplies, equipment and appliances, or nursing facility services (42 CFR §422.561).
  • State Medicaid agency contract (SMAC)– SMACs are contracts executed between state Medicaid agencies and D-SNPs. All SMACs must meet certain minimum requirements described at 42 CFR §422.107.

 

Financial Alignment Initiative demonstrations

Through the Financial Alignment Initiative, the Centers for Medicare & Medicaid Services (CMS) partnered with states to test two new models for their effectiveness in (1) providing dually eligible individuals with a better care experience and (2) better aligning the financial incentives of the Medicare and Medicaid programs. Those two models include:

  • A capitated model, through which CMS, a state, and a health plan (known as a “Medicare-Medicaid plan”) enter into a three-way contract and the plan receives a prospective, blended payment from CMS and the state to provide comprehensive, coordinated care to dually eligible plan enrollees. (California, Illinois, Massachusetts, Michigan, New York, Ohio, Rhode Island, South Carolina, Texas, and Virginia)
  • A managed fee-for-service model, through which CMS and a state enter into an agreement by which the state is eligible to benefit from savings resulting from initiatives designed to improve quality of care and reduce costs for Medicare and Medicaid. (Colorado and Washington)
  • CMS also partnered with Minnesota to implement an alternative model testing Medicare and Medicaid administrative alignment activities, building on the state’s longstanding Minnesota Senior Health Options program.