If a DSNP member loses Medicaid eligibility, what is their next step regarding enrollment?

When a Dual Special Needs Plan (DSNP) member loses their Medicaid eligibility, the appropriate next step is that they enter a grace period. This allows them time to work on reestablishing their Medicaid eligibility without losing their coverage immediately. During this grace period, the member may continue to receive the benefits of their current plan, however, they may be at risk of being disenrolled if they are unable to reestablish their eligibility before the stipulated timeframe ends.

This process is crucial because DSNPs are specifically designed to serve individuals who are eligible for both Medicare and Medicaid, and the loss of Medicaid impacts the member's eligibility to remain in the DSNP after the grace period. Therefore, this step emphasizes the importance of Medicaid eligibility in maintaining the member's enrollment in their plan.

It’s worth noting that immediately losing coverage or being automatically enrolled in a new plan does not accurately reflect the safeguards provided to members who are facing potential disenrollment.