Historical Information

Dual eligible Special Needs Plans (D-SNPs) enroll individuals who are entitled to both Medicare (title XVIII) and medical assistance from a state plan under Medicaid (title XIX). States cover some Medicare costs, depending on the state and the individual’s eligibility. States and health plans may vary in determining their eligibility categories.

What will happen with current D-SNP members in Coordinated Care Initiative counties: Los Angeles, Riverside, San Bernardino, Orange, San Diego, San Mateo¹, Santa Clara?¹

If the D-SNP Medicare plan (parent organization) has a Medi-Cal contract,² members will be passively transitioned into an exclusively aligned enrollment (EAE) D-SNP, effective January 1, 2023, and the Department of Health Care Services will reassign their Medi-Cal managed care plan to that parent organization’s Medi-Cal plan. Members will be notified via the current Evidence of Coverage and Annual Notice of Change materials sent in September.

If the D-SNP Medicare plan (parent organization) does not have a Medi-Cal contract in that county,³ members will remain in an unaligned D-SNP. Members will be notified via the current Evidence of Coverage and Annual Notice of Change materials sent in September.

¹Wellcare does not currently (2022) have D-SNP in Santa Clara or San Mateo counties.

²For Wellcare D-SNP, this will occur in Los Angeles, Riverside, San Bernardino and San Diego counties.

³For Wellcare D-SNPs, this will occur in Orange County.

The member may be enrolled in a D-SNP Look-Alike (LAL) plan through December 31, 2022. 

If they are not in a D-SNP LAL plan, their Annual Notice of Change will advise of any changes applicable to their benefits/plan for 2023.

A dual eligible beneficiary should join a D-SNP because it provides a more streamlined, hassle-free experience in navigating benefits. This is because the plan provides care coordination services that are designed to help arrange services on the member’s behalf, and often offer extra benefits beyond what beneficiaries can get from Original Medicare and Medi-Cal.

Each D-SNP plan may have different requirements.

For Wellcare D-SNP plans, enrollees must be Full Benefit Dual Eligible, Qualified Medicare Beneficiary Plus and Specified Low-Income Medicare Beneficiary Plus.

Definitions of all types of Qualified Medicare Beneficiary programs are available on the Centers for Medicare and Medicaid Services (CMS) Medicare-Medicaid Coordination Office website.

What will happen with current D-SNP members in Coordinated Care Initiative counties: Los Angeles, Riverside, San Bernardino, Orange, San Diego, San Mateo1, Santa Clara?1

If the D-SNP Medicare plan (parent organization) has a Medi-Cal contract,2 members will be passively transitioned into an exclusively aligned enrollment (EAE) D-SNP, effective January 1, 2023, and the Department of Health Care Services will reassign their Medi-Cal managed care plan to that parent organization’s Medi-Cal plan. Members will be notified via the current Evidence of Coverage and Annual Notice of Change materials sent in September.

If the D-SNP Medicare plan (parent organization) does not have a Medi-Cal contract in that county,3 members will remain in an unaligned D-SNP. Members will be notified via the current Evidence of Coverage and Annual Notice of Change materials sent in September.

1 Wellcare does not currently (2022) have D-SNP in Santa Clara or San Mateo counties.

2 For Wellcare D-SNP, this will occur in Los Angeles, Riverside, San Bernardino and San Diego counties.

3 For Wellcare D-SNPs, this will occur in Orange County.

D-SNP Look-Alike (LAL) plans (sometimes called “mirror” plans) are Medicare Advantage plans that are designed specifically to attract dual eligible beneficiaries who have secondary coverage through Medi-Cal.

As part of the 2021 Medicare Advantage and Part D (MA-PD) Final Rule (CMS-4190-F1), the Centers for Medicare & Medicaid Services (CMS) finalized new contracting limitations for D-SNP LAL plans at 42 CFR § 422.514(d) and (e): any non-D-SNP MA-PD plan with 80% or more full Medicaid members (full duals) will not be renewed for the 2023 plan year.

Generally, a member may not know if they are enrolled in a D-SNP LAL plan.

The Wellcare plan offered in 2022 and identified by the Centers for Medicare & Medicaid Services as D-SNP LAL plan is the Wellcare Plus (HMO) H5087-002.

Transitions into the exclusively aligned enrollment D-SNP will trigger the Department of Health Care Services to reassign the member’s Medi-Cal managed care plan to the same parent organization.

For Wellcare, this will occur in Los Angeles, Riverside, San Bernardino and San Diego counties. This means that the members Medi-Cal plan will become Health Net’s Medi-Cal plan.

Example:

1. Mr. Smith lives in Los Angeles County and has a D-SNP LAL with Plan A, and for his Medi-Cal managed care plan he has Plan C.

2. Mr. Smith is transitioned to Plan A’s exclusively aligned enrollment D-SNP plan, effective January 1, 2023.

3. Mr. Smith's Medi-Cal managed care plan will change automatically to Plan A's Medi-Cal managed care plan, effective January 1, 2023, to align for better care coordination.

Updated 9/10/2022

Members will be notified of 2023 plan changes by mail via the Annual Notification of Change (ANOC) in September and/or the standard non-renewal notice sent in October 2022.

The ANOC will outline specific changes in benefits between the current year (2022) and the next plan year (2023). The standard non-renewal notice provides option for enrollment into other plans for the member.

Advise your patients to ensure their Medicare plan has their current address and phone number so they receive the information.

Reassure them their Medicare D-SNP LAL plan will communicate with them via mail in October 2022. 

Ask them to make sure their Medicare plan has their current address and best contact phone number so they receive the information.

Yes. As a new D-SNP member, they are subject to the D-SNP Model of Care requirements and will be required to have an updated D-SNP HRA and individualized care plan.

The D-SNP HRAs for the transitioning D-SNP LAL members will be completed by Wellcare.