Read the original version of this article, written for the Ohio Association of Health Plans, here.

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Across the country, nearly 6 million people in 2024 qualified for both Medicare Advantage and Medicaid and were enrolled in a Dual Special Needs Plan (DSNP). That’s more than triple what it was in 2014, when just 1.54 million people had DSNP plans. These enrollees are typically 65+ years old or have a disability, and they earn less than the state’s income thresholds for Medicaid.

While they represent 18% of total Medicare Advantage (MA) members, dual-eligible plans haven’t always been easy to navigate. State and federal officials are trying to change that.

Ohio, for example, will be launching a statewide version of MyCare in 2026, called Next Generation MyCare. The goal is to put care coordination at the heart of the program. In recent conversations with dual members, I’ve heard loud and clear that it’s important for MCOs to make it easier for members to navigate Medicare and Medicaid benefits by combining them into one plan. One member even shared that “it’s less complicated, so I don’t have to spend so much time figuring out what plans covers what. Now I have more time to spend with my grandkids!”

Demystifying Dual Special Needs Plans

There are several types of dual-eligible special needs plans:

• Fully Integrated Dual Eligible (FIDE) SNPs: These are MA plans that integrate Medicare and full Medicaid benefits under one plan and one organization.
• Highly Integrated Dual Eligible (HIDE) SNPs: With these MA plans, the health plan contracts with state Medicaid agencies to provide coverage for certain Medicaid benefits. They integrate Medicare and at least one type of Medicaid service, such as long-term services or behavioral healthcare, though not to the same extent as FIDE SNPs.
• Coordination-Only DSNPs: These MA plans serve dual-eligible members, but they don’t deliver Medicaid services directly, instead focusing on coordinating care between the two programs.

The Centers for Medicare and Medicaid Services (CMS) first proposed a rule in 2022 to make the DSNP system simpler, acknowledging that dual-eligible plans can be confusing for everyone: “There remains nuance and variation that may make it difficult for members of the public—and even the professionals who support them—to readily understand what may be unique about a certain type of plan.”

That’s especially concerning because so many DSNP members have complex needs and disparities such as food, transportation, and housing insecurity that can cause barriers to health. According to KFF, nearly 9 out of 10 dual-eligible enrollees had an income of less than $20,0000, compared to 2 out of 10  Medicare beneficiaries without Medicaid coverage. And more than 40% of DSNP enrollees were in fair or poor health compared to 17% of non-Medicaid-Medicare members.

To better coordinate benefits for dual members, CMS and states are driving DSNPs toward full Medicare–Medicaid integration. HIDE and FIDE SNPs will be the standard heading into 2027, rather than the DSNP coordination-only model that has been common up until now. This means that Medicare and Medicaid benefits and their vendors must be aligned under one organization.

This is the case for the MyCare program in Ohio. The integrated program will offer members:

• A single care coordinator from the regional AAA or MyCare Plan to manage Medicare and Medicaid benefits.
• A single organization responsible for all benefits, including long-term care services and behavioral health services.
• A single organization members can contact to appeal denials.

Overcoming Transportation Challenges for Duals Plans

One benefit that is covered under DSNP plans is non-emergency medical transportation (NEMT). All states must offer Medicaid coverage of transportation, and some MA plans also offer transportation benefits.

To manage these benefits, health plans and states have turned to brokers like SafeRide Health, which works with a network of transportation providers across the nation to provide seamless transportation to members. For people who can’t drive themselves and don’t have any other transportation options, NEMT can mean the difference between getting to their doctor on time or landing in the ER.

Managing Medicare and Medicaid transportation benefits can be complex, so it makes sense for brokers to offer maximum flexibility for partner health plans. But most NEMT brokers have a one-size-fits-all approach to NEMT delivery, with technology platforms that can’t handle multiple benefit structures under a single member profile. Their manual processes can increase customer service calls, introduce more billing errors, and increase the likelihood of fraud, waste, and abuse.

SafeRide Health was founded in 2016 to solve these historical challenges. Our technology platform stores detailed member profiles that can handle any type of benefit structures, so members have a seamless, easy experience—including DSNP members. Our platform also includes automated, dynamic eligibility rule checks for every ride, cross referencing Medicare and Medicaid plan benefits. That’s true whether a member calls a customer services representative to book their ride or schedules it themself on the MySafeRide member app, or if a care provider books the ride on our platform.

SafeRide’s nationwide transportation network is also 95% digitally connected, so we can collect multiple data points about every ride: Was it on time? What type of vehicle was used? What route did the driver take? Did the member reach their appointment successfully? This ensures that our members receive the best service and makes it possible for us to proactively identify fraud, waste and abuse before it drives up costs.

Dual-eligible members must often juggle multiple health challenges, but federal, state, and health plan leaders are trying to make it easier for them to get the care they need. SafeRide Health ensures that wherever their healthcare journey takes them, transportation is the least of their worries.