New DSNP Rules starting 4/1/2025

[Patty Cake]

Maybe I missed something. I had a referral that was on Medicaid and on disability and getting Medicare 5/1/2025. Typically, there is a hiccup in the system and most people get kicked out of Medicaid and have to reapply. I was waiting until April to write her. In the meantime, today she got a letter from Humana that they have enrolled her in their DSNP as of 5/1/2025. I found out that Humana just so happens to manage her Medicaid. Is this what the new rule means? My upline did not know the answer to my questions:
1. Starting 4/1/2025 when you write a DSNP the clients Medicaid has to be the same provider on the DSNP. How are we to know who is managing their Medicaid?
2. Another DSNP would have worked better for her? Can they move to another DSNP in the future or are they locked into the same MCO?

 

[DonP]

Maybe I missed something. I had a referral that was on Medicaid and on disability and getting Medicare 5/1/2025. Typically, there is a hiccup in the system and most people get kicked out of Medicaid and have to reapply. I was waiting until April to write her. In the meantime, today she got a letter from Humana that they have enrolled her in their DSNP as of 5/1/2025. I found out that Humana just so happens to manage her Medicaid. Is this what the new rule means? My upline did not know the answer to my questions:
1. Starting 4/1/2025 when you write a DSNP the clients Medicaid has to be the same provider on the DSNP. How are we to know who is managing their Medicaid?
2. Another DSNP would have worked better for her? Can they move to another DSNP in the future or are they locked into the same MCO?

You're in a coordinated Medicare /Medicaid state . No they're not looked into that Medicaid provider . They can switch to any Medicaid provider in the state and then you can write them the companion Dsnp . Have her call her state medicaid dept and change her Medicaid provider .

 

[Patty Cake]

Will switching the MCO on the Medicaid trigger a SEP?

 

[DonP]

Will switching the MCO on the Medicaid trigger a SEP?

She's got the Iep designation for for 5/1/25 new to Medicare