Will I Lose My Medicaid if I Join a D-SNP?

Medicaid eligibility is a state decision. Medicare.gov notes that the rules about who is eligible for Medicaid are different in each state, and your state Medicaid agency is the one that approves, renews or ends your Medicaid. A Medicare plan cannot grant or remove it.

A D-SNP, by its federal definition, is a Medicare Advantage plan for people who are entitled to Medicaid, and it must have a contract with the state Medicaid agency. In other words, the plan exists to work alongside your Medicaid, not to replace it. What keeps your Medicaid active is the same with or without a D-SNP: continuing to meet your state's rules, such as its income and asset limits, and completing your state's renewal notices and paperwork on time.

Paperwork gets missed and renewals get delayed. Federal rules plan for that. If you lose Medicaid while you are in a D-SNP and you are expected to regain it, the plan may keep you enrolled for a period called deemed continued eligibility. The rule sets that period at no less than 30 days and no more than 6 months; CMS guidance says each plan picks a period from 1 to 6 months and applies it to all of its members.

During that period the plan keeps providing your Medicare benefits. It is not responsible for your Medicaid benefits, and the cost-sharing protections that come with Medicaid can lapse, so providers may bill the plan's normal cost sharing until Medicaid is restored. That is a good reason to contact your state Medicaid office quickly if you get a notice that your Medicaid is ending.

If you do not regain Medicaid, the plan must send you a notice at least 30 days before it disenrolls you, explaining the deemed period, your options and what happens next. Losing D-SNP eligibility also opens a Special Enrollment Period, which starts the month your status changes and runs until you join another plan or until 3 calendar months after the disenrollment takes effect.

This is the part worth slowing down for. A D-SNP is a Medicare Advantage plan, so it changes how you get your Medicare care.

Medicare.gov also lists a protection for people already in treatment: if you move to a new plan while getting treatment, you have at least 90 days before the new plan can ask you to get a new prior approval for that ongoing treatment.

For questions about your Medicaid eligibility, call your state Medicaid agency. For impartial Medicare counseling, your State Health Insurance Assistance Program (SHIP) can help. For how a specific plan works with your Medicaid, a licensed agent can walk you through the plans they offer in your area. Our guide to Medicare and Medicaid together covers the basics, and the Indiana guide includes what that state says about its own integrated program.