Why Most Health Plans Still Struggle to Deliver on the D-SNP Integration Promise

Dual Eligible Special Needs Plans were designed to seamlessly coordinate Medicare and Medicaid for beneficiaries, but most health plans remain far from achieving this operationally. Medicaid-dominant plans bring strong LTSS and community relationships but lack Medicare Star rating and risk adjustment expertise, while Medicare-focused plans excel at utilization management but struggle with state oversight and community-based service coordination. The article argues this structural mismatch between organizational capabilities and D-SNP requirements remains the defining operational challenge for plans serving dually eligible populations.

Managed Care · LTSS · Finance

This is outside commentary from Sellers Dorsey, not part of Medicaid Monitor's independently scored news coverage.

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