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ACAP Proposes Five Options to Leverage Dual Eligible Special Needs Plans to Improve Care for Medicare Beneficiaries
FOR IMMEDIATE RELEASE: December 16, 2025
FOR MORE INFORMATION: Marty Johnson, (202) 420-7424; mjohnson@communityplans.net
ACAP Proposes Five Options to Leverage Dual Eligible Special Needs Plans
to Improve Care for Medicare Beneficiaries
WASHINGTON — A new report from the Association for Community Affiliated Plans (ACAP) illuminates five proposed demonstration programs to leverage Dual-Eligible Special Needs Plans (D-SNPs) to improve the quality and accessibility of coverage, better manage chronic conditions and promote aging in place.
D-SNP beneficiaries — people who qualify for both Medicaid and Medicare services — often have complex sets of needs, including chronic conditions, behavioral health and long-term care support, aging in place limitations, and more. The paper is the culmination of a months-long undertaking by ACAP to find pathways for health plans to improve the health outcomes of beneficiaries as well as non-dually-eligible patients.
“Our Safety Net Health Plans are pivotal to the success and sustainability of D-SNPs, as they comparatively direct more money to medical care and less to overhead costs,” ACAP CEO Margaret A. Murray said. “These proposed demonstrations will improve plans’ management of chronic conditions, and leverage plans’ expertise to improve the sustainability of the Medicare Advantage for Medicare beneficiaries with high levels of medical need.”
In the report, ACAP encouraged the Centers for Medicare & Medicaid Services (CMS) to engage in five demonstrations aimed at identifying the best strategies for elevating important aspects of care. They include:
- “Near-Duals” Demonstration: Designed to improve care coordination and access to care for the “near-duals” population: low-income Medicare beneficiaries who are not currently eligible for Medicaid.
- D-SNP Housing Supports Demonstration: Designed to test the role and impact of D-SNPs partnering and coordinating with housing providers for Medicare beneficiaries to provide enhanced supportive housing services.
- Behavioral Health and SUD Risk Model Innovations: Designed to test risk-adjustment innovations that can improve the accuracy of risk adjustment for Medicare beneficiaries with behavioral health conditions, including severe and persistent mental illness (SPMI) and substance use disorder (SUD) diagnoses.
- Medicare Advantage Coding Reform: Offers solutions for CMS to address coding differences between MA and Medicare fee-for-service (FFS).
- D-SNP-Specific Quality Measurement System: Designed to correct the measure and quality of care received by D-SNPs beneficiaries.
“Given the abundance of opportunities for reform, these proposals can serve as a guidepost for future CMS demonstrations to improve care for dually eligible and middle- and lower-income Medicare beneficiaries,” the report adds. “ACAP and its member D-SNP plans will continue to work with members of the policy community to refine these opportunities for innovation in chronic care management, aging in place, and advancement in Medicare and Medicaid integration.”
Read the full report here.
ABOUT ACAP
ACAP represents 86 health plans, which collectively provide health coverage to more than 30 million people. Safety Net Health Plans serve their members through Medicaid, Medicare, the Children’s Health Insurance Program (CHIP), the Marketplace and other publicly-sponsored health programs. For more information, visit communityplans.net.
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