What happens to a DSNP member's coverage if they do not reestablish Medicaid eligibility after losing it?

When a Dual Special Needs Plan (DSNP) member loses Medicaid eligibility, it is essential to understand how their coverage is impacted. If the member does not take steps to reestablish Medicaid eligibility, they will be disenrolled from the DSNP after a grace period. DSNPs are designed specifically for individuals who are eligible for both Medicare and Medicaid; thus, the loss of Medicaid eligibility compromises the basis for the member’s enrollment in the DSNP. The grace period provides the member time to navigate the reapplication process for Medicaid, but ultimately, if they remain ineligible, disenrollment from the DSNP is the necessary outcome.

This framework is established to ensure that DSNPs serve those who meet both Medicare and Medicaid criteria, ensuring continuity in coverage for individuals who are able to maintain their eligibility for both programs.