Changes Are Coming For Delawareans Enrolled In Both Medicaid and Medicare

Date: 05/09/25

The State of Delaware announced that it is making changes that will improve health outcomes for members enrolled in both Medicaid and Medicare.  Effective January 1, 2026, Delaware will require that beneficiaries of Dual Eligible Special Needs Plans must be “exclusively aligned”.

Members enrolled in both Medicaid and Medicare are known in the industry as “duals”.  Duals are eligible to enroll in a special Medicare Advantage (“MA”) plan known as a Dual Eligible Special Needs Plan (“D-SNP”).  In addition to offering extra benefits beyond normal MA plans, D-SNPs better streamline the healthcare needs of dually enrolled beneficiaries.

By January 1, 2026, to operate a D-SNP in Delaware, Medicare companies with D-SNPs must also have been awarded a Medicaid Managed Care Organization (“MCO”) contract by the State.  In other words, to offer a D-SNP moving forward, the Medicare company offering the D-SNP must also own or share the same parent company as the Medicaid company.  For example, members enrolled in a Wellcare D-SNP must also be enrolled with Delaware First Health’s Medicaid plan.  (Note that both companies are owned by Centene.)  

D-SNPs currently operating in the Delaware market whose company or parent company was not awarded a Medicaid MCO contract by the State (i.e., United, Aetna, Cigna, etc.) will be permitted to operate for an optional one-year grace period in 2025.  This will allow a smoother transition for those D-SNPs and give time for their enrollees to consider other options.  Those D-SNPs will also be prohibited from enrolling new dually eligible members in 2025.

What this means is that current D-SNP beneficiaries who are enrolled in a D-SNP that is not affiliated with a Medicaid MCO must switch to an aligned plan, likely during the annual open enrollment period.  People who become dually eligible in 2025 can join an aligned plan now.

This is an important initiative that will impact many Delawareans. With the Medicare and Medicaid companies aligned, information sharing increases tremendously – benefiting the enrollee who now has better care coordination. We applaud the State of Delaware for this change as it will certainly improve the quality of life and health outcomes for D-SNP beneficiaries.

If you are enrolled in a D-SNP, or you know someone who is, please let them know of the upcoming change. They may need to change their D-SNP during the open enrollment period, which is from October 15 to December 7. You can also encourage them to reach out to a licensed Medicare broker or a state health insurance assistance program counselor for more information.

At Delaware First Health, our mission is to improve the health of the communities we serve, one person at a time. This change by the State will help us achieve that mission.