What should be done when a member's eligibility for a D-SNP changes?

When a member's eligibility for a Dual Special Needs Plan (D-SNP) changes, they become responsible for all cost-sharing requirements associated with their new eligibility status. D-SNPs are designed to provide Medicare benefits to eligible individuals who also receive Medicaid benefits, often catering to low-income individuals, seniors, and those with disabilities. When the eligibility changes, the financial structure that supports the cost-sharing may also shift, leading to the member being liable for out-of-pocket costs that were previously covered under their D-SNP plan.

It's also important to consider the implications of option A. While the member can appeal certain decisions regarding their eligibility, appealing costs is not an automatic right when there is a change in eligibility status. As for option C, grace periods typically apply in specific contexts such as premium payments, but this does not directly relate to a change in eligibility for D-SNP benefits. Lastly, option D implies an automatic upgrade in status, which is misleading, as changes in eligibility can often lead to a decrease in coverage rather than an upgrade. Therefore, the correct understanding is that the member bears responsibility for their cost-sharing obligations following a change in their eligibility for the D-SNP.