Over the next 18 months, some of the country’s largest and most complex dual-eligible programs—across Michigan, Ohio, Illinois, Massachusetts, and Texas—are undergoing major structural reform. These states are moving from fragmented demonstrations and passive alignment to Highly Integrated Dual Eligible Special Needs Plans (HIDE SNPs) and Fully Integrated D-SNPs (FIDE SNPs).
This transition will bring new opportunities—but also new responsibilities. And one thing is clear: D-SNPs are no longer just Medicare Advantage plans with a Medicaid tail. They are now full-service care delivery platforms with accountability across medical, behavioral, and in-home service domains.
At the center of this shift is a long-overlooked pillar of care: Long-Term Services and Supports (LTSS).
The National Push Toward Integration
In 2023, the Centers for Medicare and Medicaid Services (CMS) finalized a rule requiring D-SNPs to coordinate Medicaid benefits under formal contracts with state Medicaid agencies. This includes managing LTSS, behavioral health, and social supports under a single administrative umbrella.
This exclusively aligned enrollment model signals CMS’s intention to phase out duals fragmentation and move toward fully accountable, person-centered care for the most complex and costly populations in Medicare.
While the Biden administration has prioritized this effort with clear timelines and funding pathways, the Trump campaign has not yet publicly addressed whether it would maintain or revise this direction. However, GOP-backed proposals suggest continued expansion of Medicare Advantage, which implicitly supports integrated models where plans carry more responsibility.
Why In-Home Networks Now Sit at the Core of D-SNP Performance
Under HIDE and FIDE SNP models, health plans are not just encouraged—but required—to deliver and coordinate Medicaid-covered LTSS such as:
- Personal care assistance
- Home-delivered meals
- Non-emergency medical transportation
- Home safety assessments
- SDOH-related supports
These services are not optional extras. They are essential to reducing hospitalizations, preventing institutionalization, and meeting both quality and cost targets.
Most Medicare Advantage infrastructure was not built to manage these networks. LTSS providers operate hyper-locally. Availability changes daily. Capacity varies by zip code. And referrals are still made by phone or fax in many markets.
This is where the care model—and the economics—break down.
Learn how Dina helps SNPs accelerate access to personal care services and LTSS while significantly reducing administrative spend.
Set up a quick meet and greet call today.
What Plans Are Up Against
Most health plans heading into this new landscape are facing:
- No pre-existing LTSS provider network (especially in states like Michigan and Ohio, where the burden is fully on the plan)
- No digital directory of in-home providers by geography, capacity, or credentialing
- No way to track fulfillment or confirm that members received services
- No scalable referral process that avoids staff-intensive, manual workflows
- No analytics layer to support adequacy, quality, or cost tracking
These gaps are not just operational—they’re strategic liabilities. D-SNPs undergoing or anticipating a shift to HIDE & FIDE models need to evaluate their internal capabilities while looking at external partners to significantly lessen this new administrative burden. During that evaluation, many plans will find that their existing network teams are focused on traditional service line management and their care managers will not be able to assume a substantially higher volume of coordination work without the right tools.
CMS is forcing the hand of non-integrated D-SNPs and plan operators will need to rise to the challenge.
The Good News!
Dina’s platform and network management capabilities are built specifically for this transition.
We help health plans:
- Rapidly identify, credential, and contract in-home service providers by zip code, service line, and availability
- Digitize referrals with eligibility logic, geographic filtering, and real-time routing
- Monitor fulfillment to close the loop and track value
- Proactively manage network adequacy and document compliance for state and CMS audits
Dina is leading the charge on in-home network management and rethinking how health plans ensure quality service delivery and access to their most vulnerable populations.
The LTSS reboot is here. D-SNPs that succeed in this new environment will be the ones that treat in-home care as a strategic pillar, not an afterthought.
If you’re building—or rebuilding—your D-SNP model to meet HIDE/FIDE requirements, Dina can help you move from reactive to ready.
