Resources

Beginning January 1, 2030, Dual Eligible Special Needs Plan (D-SNP) enrollment must be fully aligned with Medicaid plan enrollment, and beneficiaries will no longer be able to stay in their current D-SNP. Building on a previous ATI resource, this brief outlines a transitional strategy for states subject to the impending D-SNP enrollment alignment requirements to consider.

The Transforming Episode Accountability Model (TEAM) completes its first half-year of performance year one on July 1, 2026. For the 740-plus acute care hospitals required to participate, the model's upside-only period has provided an early look at episode-level performance data and a runway to prepare for mandatory downside risk beginning on January 1, 2027.

The Kim Frailty Index (KFI) is a validated, peer-reviewed measure of frailty that uses only healthcare claims data to measure frailty with sufficient accuracy for population-level decision making. The CMS Innovation Center is embedding KFI data into its Long-term Enhanced ACO Design (LEAD) Model as one of the factors used to assess whether a beneficiary qualifies as "High Needs."

While work requirements have captured the Medicaid policy conversation, CMS' Ensuring Access to Medicaid Services Final Rule (CMS-2442-F) is already moving from policy into implementation, with some provisions taking effect now and others phasing in through 2028 and beyond.

New research from ATI shows that in 2023, Institutional Special Needs Plan (I-SNP) enrollees had lower mortality risk and fewer emergency department visits, hospitalizations, and hospital readmissions than non-I-SNP MA beneficiaries. This brief investigates the association between I-SNP enrollment and mortality, healthcare utilization, spending, and quality outcomes for long-term care residents enrolled in Medicare who had one or more nursing facility stays of 90 days or longer during the year.

ATI’s latest resource draws on analysis of CMS enrollment data to map where C-SNP growth is happening and which populations and conditions represent the highest-value opportunities. The tool provides considerations for building a high-performing plan, walking through five critical decision points and a six-phase launch roadmap while identifying common pitfalls.