Dual Eligible Special Needs Program (D-SNP)

Overview of Dual Eligible Special Needs Plans

Nevada has over 86,000 Dual Eligible recipients. With such a large population of dual-eligible recipients with high utilizations of Medicaid services, there are opportunities to better coordinate care through a D-SNP program with the goal of improving quality of care and the addition of more services.  

Nevada has a Coordination Only Dual Eligible Special Needs Plan (CO D-SNP) which is an optional program within Medicare Advantage plans for individuals who are eligible for both Medicare and Medicaid coverage. This program is designed to coordinate care among Medicare and Medicaid to improve care more effectively while also lowering costs. In addition to care coordination, CO D-SNPs can also offer supplemental benefits not typically available under Medicare but offered through Medicaid programs. 

Eligibility for D-SNP

A person must be eligible and enrolled in Medicare Part A and/or Part B and receiving Medicaid benefits or Medicaid assistance with Medicare premiums or cost sharing. There are different types of dual-eligible recipients. A Full Benefit Dual Eligible (FBDE) and Qualified Medicare Beneficiary Plus (QMB+) has access to all Medicaid services and Medicaid also pays for the Medicare premiums, co-insurance, and deductible. For a Qualified Medicare Beneficiary (QMB), Medicaid only pays an individual's Medicare premiums, co-insurance and deductible amounts up to Medicaid allowable amounts. 

 Nevada has chosen these three dual eligible categories to participate in DSNP: 

• Full Benefit Dual Eligible (FBDE)
• Qualified Medicare Beneficiary (QMB)
• Qualified Medicare Beneficiary Plus (QMB+)

Recipients who enroll in a D-SNP who are Full Dual Eligible DO NOT lose any existing Medicaid benefits for their current benefit plan such as Personal Care Services and Non-Emergency Transportation. 

Services Offered

Nevada Medicaid has chosen to make the following eight (8) services available for eligible D-SNP recipients.

• Dental
• Vision
• Hearing Aids
• Non-emergency transportation to and from medical visits, including pharmacy
• Personal Emergency Response Systems (PERS)
• Nursing Hotline
• Telemedicine
• Meal Services after a hospital stay

Nevada Plans

Nevada currently has a State Medicaid Agency Contract (SMAC) with 10 Medicare Advantage Plans. Each plan can offer the eight services listed above as well as additional services offered to a CO D-SNP member as detailed on the right by each plan.

D-SNP Evaluation and Procurement

Program Evaluation

In 2022, Nevada was awarded a grant through the Arnold Venture Foundation to strengthen its D-SNP program. Through this grant opportunity, Nevada Medicaid received Technical Assistance from Mercer to evaluate options for improvements towards advancing integration of Medicaid and Medicare services for Nevada's dual population. 

The results of that evaluation, and consideration for improvements, are outlined in the following report. 

Nevada Dual-Special Needs Plan Report   

Procurement 

Beginning in 2024, Nevada revised its process for selecting DSNP Plans for State Medicaid Agency Contracts (SMACs) to now require a procurement before a plan will be awarded a SMAC. Prior to issuing the first procurement, Nevada Medicaid solicited feedback for consideration of that procurement. 

The following are received from the- Solicitation of Public Input for DSNP RFP.

1. Aetna  
2. Anthem 
3. CareSource  
4. Humana 
5. Molina   
6. Prominence 
7. SCAN  
8. Silver Summit  
9. United Health Care

Issuance of Procurement- December 2025 to January 2026   

• Notification of Awardees
  • Letter of Intent-March 2026 
  • Notice of Award- April 2026 
  • Board of Examiners- May 2026 
  • Contract Begin- January 2027