Aligned enrollment for Virginia D-SNP members starting January 1, 2025

Members enrolled in both Medicaid and a Medicare Advantage Dual Special Needs Program (D-SNP) currently receive their Medicare benefits and Medicaid benefits separately, especially if they have two different health plans. This current arrangement can be very confusing for the D‑SNP/Medicaid enrollee, their healthcare providers, and the health plans because of uncoordinated care, communications, and outreach. Effective January 1, 2025, this will change.

Exclusively aligned enrollment happens when a Medicare Advantage D-SNP enrollee, who also has Medicaid coverage, receives all benefits and services from the same health plan. Benefits of exclusively aligned enrollment include:

• One plan that coordinates all care.
• Integrated member materials, such as one Medicare/Medicaid ID card, member handbook, and other documents that include information about coverage in both Medicare and Medicaid.
• A comprehensive network of healthcare providers.
• Timely coordination of care.
• Reduced confusion for members and care providers.
• Easier access to specialists who are contracted with both Medicare and Medicaid.
• Better health outcomes
• Automatic coordination of benefits for claim processing.

The big change

If a member is in a Virginia Medicare Advantage D-SNP health plan and also has Medicaid, they will be required to have one health plan as of January 1, 2025. This change will occur on December 18, 2024, as mandated by the Commonwealth of Virginia for an effective date of January 1, 2025.

We are sending this to you to inform and update, as this may cause member and care provider confusion. More information from the Commonwealth of Virginia can be found here.

Through genuine collaboration, we can simplify access to care and help you deliver high-quality, equitable healthcare.