California Health Plans are facing an unprecedented transformation in how they serve Dual Eligible Special Needs Plan (D-SNP) members. The California Advancing and Innovating Medi-Cal (CalAIM) initiative is rapidly reshaping the D-SNP landscape, creating an urgent mandate for plans to adapt or risk being left behind. Cal-AIM’s goal is having Medicare and Medi-Cal benefits managed by the same organization to promote better care coordination and care experience for members to drive better outcomes. With strict implementation timelines already in motion and significant operational changes required, the window for strategic action is closing quickly.
Understanding the D-SNP Population in California
D-SNP members represent a uniquely vulnerable population. These individuals qualify for both Medicare and Medicaid (Medi-Cal in California) and often face complex health and socioeconomic challenges. Nearly 90% live on annual incomes below $20,000, and many manage multiple chronic conditions, with a significant portion reporting five or more such conditions. This population also experiences higher rates of mental health issues, including anxiety, depression, and schizophrenia.
Beyond health conditions, D-SNP members face significant social determinants of health challenges. Many experience food insecurity, housing instability, and transportation barriers. Data shows that D-SNP enrollees are predominantly female and more likely to live alone, with approximately 87% residing in urban areas. In areas like Florida, a notable segment has limited English proficiency, with Spanish, Haitian, and Vietnamese being commonly reported languages among this diverse population.
The CalAIM Mandate: No Time to Wait
The CalAIM initiative isn't just another regulatory change—it's a fundamental reconstruction of California's D-SNP ecosystem with non-negotiable deadlines. The Department of Health Care Services (DHCS) has already begun implementing its vision for integrated "Medi-Medi Plans" through Exclusively Aligned Enrollment (EAE) D-SNP models in 12 counties, with statewide expansion imminent in 2026.
The regulatory timeline leaves no room for procrastination:
- Already in Effect: DHCS will not sign a State Medicaid Agency Contract (SMAC) with any proposed new D-SNP in any county unless it has an affiliated Medi-Cal plan.
- Currently Enforced: New enrollment in D-SNPs is restricted to only those with an affiliated Medi-Cal plan. D-SNPs without this affiliation can no longer enroll new members.
- January 2026: The EAE D-SNP model will expand to numerous additional counties across California, requiring substantial operational readiness.
- January 2027: CMS will mandate that D-SNP enrollment be limited to individuals enrolled in affiliated Medicaid managed care organizations.
This accelerated timeline means Health Plans must transform their D-SNP communication and care coordination approaches immediately. Those who delay implementation of integrated solutions face existential business risk in California's D-SNP market.
The Communication Crisis
Effectively reaching and engaging D-SNP members presents formidable obstacles:
- Low Health Literacy: Many D-SNP members struggle to understand complex health information, making it difficult to navigate the healthcare system and make informed decisions.
- Language and Cultural Barriers: With significant linguistic diversity, plans must provide multilingual communication and culturally sensitive messaging.
- Fragmented Care Coordination: The separation between Medicare and Medicaid systems creates coordination challenges, leading to potential gaps in care and member confusion.
- Contact Challenges: Housing instability and frequent address changes make maintaining accurate contact information difficult, resulting in wasted resources on undeliverable communications.
- Trust Deficit: Many members have pre-existing skepticism toward health plans, requiring sustained effort to build meaningful engagement.
These barriers don't just impact member satisfaction—they directly affect health outcomes, Star Ratings, and bottom-line results. When D-SNP members miss important communications about their benefits or care, it can lead to medication non-adherence, missed preventive services, and ultimately, preventable hospitalizations and emergency department visits.
The Cost of Ineffective Communication
For Health Plans, the financial implications of communication failures are substantial. Traditional outreach methods like paper mailings are not only environmentally wasteful but costly and increasingly ineffective—especially in populations that are increasingly transient. Call centers struggle with low answer rates and lengthy handle times when trying to explain complex benefit information. Meanwhile, preventable healthcare events resulting from poor communication drive up medical costs.
Administrative waste compounds these challenges. The duplication of services due to lack of coordination between Medicare and Medicaid, unnecessary utilization of healthcare resources, and the administrative overhead of managing two distinct programs all contribute to inflated costs. Data shows that while dual-eligible beneficiaries constitute approximately 19% of the total Medicare population, they account for a substantial 34% of all Medicare spending.
Ushur: The Ready-Now Solution for CalAIM D-SNP Compliance
Meeting CalAIM's urgent integration requirements demands purpose-built solutions that can be implemented immediately. Ushur's AI-powered engagement platform is especially well-positioned to address the complex communication challenges of California's D-SNP transformation:
- CalAIM-Ready Integration Capabilities: Ushur's platform can help bridge the communication gap between Medi-Cal plans and D-SNP beneficiaries, creating the seamless experience required by CalAIM's EAE D-SNP model from enrollment, to Health Risk Assessment surveying—and throughout the plan year—to support better health outcomes. Implementation can begin in weeks, not months or years.
- Multilingual Conversational AI: With California's D-SNP population requiring communication in multiple languages, Ushur enables real-time, culturally appropriate outreach across SMS, email, and other digital channels.
- Regulatory Compliance Automation: As DHCS and CMS requirements evolve, Ushur's HITRUST-certified and HIPAA-compliant Customer Experience Automation platform securely delivers all required Medicare and Medi-Cal notifications, protecting sensitive member data while meeting stringent regulatory standards.
- D-SNP Member Retention Tools: With new enrollment restrictions already affecting non-integrated D-SNPs, Ushur's proactive medication adherence and care gap closure solutions help maintain positive relationships with existing members while improving health outcomes.
- SDOH Integration for Whole-Person Care and Health Equity Support: CalAIM emphasizes addressing social determinants of health and health equity barriers—Ushur's digital SDOH assessment support helps identify non-medical barriers and automatically connect members with appropriate resources, fulfilling a critical CalAIM objective.
The Critical Imperative: Act Now or Be Left Behind
The CalAIM transformation isn't approaching—it's here. California Health Plans face an immediate choice: proactively implement integrated communication solutions or struggle to maintain relevance in the state's rapidly evolving D-SNP landscape.
With DHCS already enforcing restrictions on D-SNPs without affiliated Medi-Cal plans and the statewide expansion of the EAE model just months away, the time for planning and deliberation has passed. Health Plans need immediate action to:
- Implement seamless communication systems that bridge Medicare and Medi-Cal benefits
- Deploy engagement solutions that overcome the significant barriers of low health literacy and linguistic diversity
- Establish coordination workflows that eliminate fragmentation between programs
- Create scalable infrastructure to support the inevitable expansion of integrated models
The consequences of inaction are severe. Health Plans that fail to adapt will face member attrition, regulatory compliance challenges, and potential exclusion from California's D-SNP market altogether. Conversely, those that move swiftly to implement intelligent engagement solutions will not only survive the transition but thrive—achieving higher Star Ratings, improved member outcomes, and a dominant position in this critical market segment.
With CalAIM's implementation timeline already in motion, the window for transformation is closing rapidly. The question isn't whether to evolve your D-SNP communication strategy, but how quickly you can deploy the solutions needed to succeed in California's new integrated care landscape.