Transforming Care for the Dually Eligible Population in California Through Aligned Managed Medicaid and Medicare Advantage Plans

August 2025

This page contains useful resources for APG members and others seeking to improve the care of America’s dually eligible population

Dually eligible beneficiaries, sometimes called “duals,” are people enrolled in both Medicare and Medicaid because of their age or disability and low incomes. Medicare pays for their acute and post-acute care, while Medicaid helps with paying their Medicare premiums and cost sharing and services that Medicare doesn’t cover, such as long-term services and supports (LTSS). The nation’s nearly 13 million duals have a wide range of health status and needs, from being relatively healthy to having multiple chronic conditions, physical disabilities, mental illness, and cognitive impairments such as dementia.

The challenges posed by navigating two different programs has prompted the states and the federal government to seek ways to “integrate” duals’ coverage and transform their care. One option available to duals is to enroll in one of several types of so-called Special Needs Plans, including Dual Eligible Special Needs plans (D-SNPs), which are a type of Medicare Advantage (MA) plan that must also contract with a state Medicaid agency and coordinate Medicaid benefits for enrollees. In addition, D-SNPs that are closely affiliated – or “aligned” – with a specific managed Medicaid plan can better coordinate the Medicare and Medicaid benefits and provide better care experiences for enrollees.

Proportionately fewer duals are enrolled in aligned D-SNPs than may be desirable.  For example, in California, only 19 percent of the state’s 1.7 million dually eligible enrollees receive their benefits and care coverage through aligned D-SNPs.  In 2026, however, California is set to expand the number of aligned MA and Medicaid (Medi-Cal) plans, called “Exclusively Aligned Enrollment D-SNPs,” or EAE D-SNPs, under a Medicaid waiver from the federal government and an initiative called CalAIM (California Advancing and Innovating Medi-Cal).  Duals enrolled in EAE D-SNPs will also be enrolled in a Medi-Cal managed care plan affiliated with the D-SNP, thus enabling further coordination of benefits and coverage.

If implemented effectively, EAE D-SNPs have tremendous potential to ensure that duals receive highly integrated care that enhances their health outcomes and care experience. Opportunities also exist for engaging more physician groups to work in close partnerships with aligned D-SNPs.  Many members of America’s Physician Groups are already in capitated and delegated relationships with D-SNP plans and have gained great insights into how to manage duals’ care effectively under these arrangements.  (Capitation is a payment model in which physician groups or other health care providers receive a fixed, pre-set payment for each patient, such as from an MA health plan; delegation involves the plan assigning specific responsibilities or tasks to the medical group in tandem with the capitated payment, such as utilization management.)

Twenty APG members, who serve more than 200,000 duals in California, shared their experiences in interviews conducted from September 2024 to January 2025.  APG then developed three issue briefs based on the content of these interviews to help support the successful implementation of California’s aligned D-SNPs.  Each focuses on a specific stakeholder audience: California policymakers, health plans, and medical providers.  Although tailored to many of the circumstances in California, these briefs also hold lessons for physician groups, D-SNP plans, and Medicaid managed care organizations in other states as they work together to improve the care and outcomes of America’s duals population.

View Full Issue Briefs:

• Partnering in Successful CalAIM D-SNP Implementation:                                        Insights and Considerations for Capitated and Delegated Medical Providers

• Physician Organizations and Successful CalAIM D-SNP Implementation: Insights and Considerations for California Policymakers

• Physician Organizations and Successful CalAIM D-SNP Implementation: Insights and Considerations for Health Plans