Arizona D-SNP and ALTCS Plans 2026: When the Two Must Match

If you're an elderly or physically disabled member of the Arizona Long Term Care System (ALTCS) and you have a fully integrated (FIDE) D-SNP, it must be aligned with your ALTCS health plan.1,2 In practice, your Medicare plan and your Medicaid long-term care plan come from the same company, because a FIDE D-SNP (dual eligible special needs plan) is delivered through a single company holding both the Medicare Advantage contract and the Medicaid managed care contract.3 The Arizona Health Care Cost Containment System (AHCCCS), Arizona's Medicaid agency, restated that rule for ALTCS Elderly and/or Physically Disabled (E/PD) members in May 2026, with alignment effective when the next Medicare plan year starts.2 If you're on AHCCCS through an AHCCCS Complete Care (ACC), ACC-RBHA or DES Division of Developmental Disabilities (DDD) plan instead, your plan's company must offer a companion D-SNP too, and this guide shows how that kind differs, when a D-SNP can enroll you by default, and how to switch.2

In This Guide

• How AHCCCS Pairs Your Medicaid Plan With an Arizona D-SNP
• ALTCS Members: The FIDE D-SNP and the Alignment Rule
• ACC, ACC-RBHA and DDD Members: HIDE D-SNPs
• When You First Get Medicare: Default Enrollment
• How to Switch Plans During the Year
• If You Only Have a Medicare Savings Program
• Keeping Your D-SNP Through an AHCCCS Renewal
• Your Arizona D-SNP in 2027
• Before You Change Either Plan, Call Arizona SHIP
• Frequently Asked Questions
• Learn More

How AHCCCS Pairs Your Medicaid Plan With an Arizona D-SNP

A D-SNP is a Medicare Advantage plan that enrolls people entitled to both Medicare and Medicaid and coordinates both programs' services.8 Under AHCCCS Contractor Operations Manual Policy 107, each AHCCCS Complete Care (ACC), ACC-RBHA, ALTCS E/PD and DES Division of Developmental Disabilities (DDD) health plan contractor must offer a CMS-approved affiliated D-SNP at the start of each calendar year in every county of each geographic service area it was awarded, and AHCCCS contracts with a contractor's companion D-SNP only in those counties.2 Policy 107 also sets which integration tier CMS must designate each year for that companion D-SNP, depending on the Medicaid plan it's paired with.

The federal Centers for Medicare & Medicaid Services (CMS) lists Arizona among the states with FIDE and HIDE SNPs, and not among the states with coordination-only D-SNPs, in its contract year 2026 integration-status file.2 Nationally, the Medicare Payment Advisory Commission (MedPAC) found that in 2024 only 3 percent of all dual eligibles were in FIDE SNPs and 15 percent in HIDE SNPs, while 27 percent were in coordination-only D-SNPs.9

This guide doesn't name ALTCS plans or their D-SNPs. AHCCCS's ALTCS E/PD procurement (RFP YH27-0001) can change which companies hold ALTCS E/PD contracts, so ask your plan or Arizona SHIP which D-SNP is paired with yours.2

ALTCS Members: The FIDE D-SNP and the Alignment Rule

The Arizona Long Term Care System (ALTCS) is AHCCCS's long-term care program for people with an age-related, physical, or intellectual or developmental disability who need nursing facility level of care. ALTCS members don't have to live in a nursing home, and many live in their own homes or an assisted living facility and get in-home services.1 For 2026, the ALTCS gross monthly income limit for one person is $2,982, which is 300% of the $994 Supplemental Security Income (SSI) federal benefit rate.1 Our guide to Arizona Medicaid income and asset limits covers the full financial test.

For an ALTCS E/PD member, the FIDE tier also sets a federal floor for what your plan company covers. A FIDE SNP's Medicaid contract must cover primary and acute care, long-term services and supports (including at least 180 days of nursing facility coverage during the plan year) and, since 2025, behavioral health, home health and medical equipment, to the extent the state's Medicaid program covers them, and the plan operates with exclusively aligned enrollment.3

The alignment rule. In Major Decision 7 for the ALTCS E/PD procurement, posted May 26, 2026, AHCCCS said ALTCS/EPD contractors will be required to have a companion FIDE D-SNP. AHCCCS's Major Decision 7 also said that, as has been the case, ALTCS E/PD members who have a FIDE D-SNP must align their D-SNP with their Medicaid plan, effective when the next Medicare plan year starts.2 Before changing either your ALTCS plan or your D-SNP, ask your ALTCS case manager or Arizona SHIP how the change affects the other plan.

What the FIDE D-SNP changes about appeals

FIDE SNPs are applicable integrated plans, which handle Medicare and Medicaid grievances and appeals through one integrated process instead of two separate tracks.3 For a member of an applicable integrated plan, the rules work like this:10

• Filing deadline: 60 calendar days after you receive the plan's denial notice; receipt is presumed to be 5 days after the notice date, which CMS guidance states as 65 calendar days from the date on the notice.
• Decision time: 30 calendar days for a standard plan-level appeal and 72 hours for an expedited one, which the plan must grant if waiting could seriously jeopardize your life, health or ability to regain maximum function.
• Keeping services during the appeal: if a plan cuts or stops services it had approved, the services were ordered by an authorized provider and the original approval period hasn't ended, your Medicare Part A and Part B and Medicaid benefits continue while the appeal is pending, as long as you file the appeal on time and ask for continuation by the later of 10 calendar days after the plan sends its notice or the date the change takes effect.11
• After the plan decides: if the plan upholds a Medicare denial, it must send the case to an independent review entity itself; for a Medicaid denial, you can request a State fair hearing.12

Our guide to Arizona Medicaid appeals and fair hearings covers the state side.

ACC, ACC-RBHA and DDD Members: HIDE D-SNPs

If your AHCCCS plan is an ACC, ACC-RBHA or DDD plan, your plan company's D-SNP is the highly integrated (HIDE) tier in the table, and one practical difference is appeals. CMS's contract year 2026 file marks none of Arizona's HIDE packages as an applicable integrated plan, so a member of one of those D-SNPs shouldn't expect the single combined appeal process described above.2,3

The HIDE D-SNP is still within reach mid-year. The monthly Integrated Care Special Enrollment Period covers HIDE SNPs as well as FIDE SNPs, as long as the move aligns your D-SNP with your Medicaid managed care plan.6

When You First Get Medicare: Default Enrollment

If you're in an AHCCCS health plan when you first become eligible for Medicare, the plan's companion D-SNP may enroll you by default. Under 42 CFR 422.66(c)(2), that can happen only if every federal condition is met, including that you're still enrolled in the affiliated Medicaid managed care plan, the state has approved default enrollment in its contract with the D-SNP, CMS has approved the organization, the organization has an overall quality rating of at least 3 stars (or is a low enrollment contract or new plan), and you haven't declined or chosen other coverage before it takes effect.4

Default enrollment takes effect the month you're first entitled to both Medicare Part A and Part B. At least 60 calendar days before a default enrollment takes effect, the D-SNP must send a notice explaining how its premium, benefits and cost sharing differ from your Medicaid plan, and that you can decline up to and including the day before the enrollment starts and choose Original Medicare or another Medicare Advantage plan instead.4

In Arizona, Policy 107 requires each contractor's companion D-SNP to get separate CMS approval before it does default enrollment. CMS's chart of plans approved for default enrollment as of March 31, 2026 lists ten Arizona D-SNP plan packages.5 CMS notes that most approved organizations are submitting default enrollments but that newly approved ones may still be setting the process up.5 If a default enrollment notice arrives, read it before the deadline it gives.

How to Switch Plans During the Year

Since January 1, 2025, dual eligibles have two monthly Special Enrollment Periods, and each change takes effect the first day of the next month.6

The Dual/LIS Special Enrollment Period isn't available to someone a Part D drug management program has identified as a potential at-risk or at-risk beneficiary, for as long as that identification stands.13 A full-benefit dual eligible who stays in Medicaid fee-for-service or an unaligned Medicaid plan can't use the Integrated Care Special Enrollment Period.6 For an ALTCS member with a FIDE D-SNP, AHCCCS's alignment rule applies on top of these windows.2 Our guide to Medicare Special Enrollment Periods covers the other change windows.

If You Only Have a Medicare Savings Program

AHCCCS runs the Medicare Savings Programs as QMB, SLMB and QI-1, with no resource test for any of them. In 2026, AHCCCS's Qualified Medicare Beneficiary (QMB) limit is $1,330 a month for one person or $1,804 for a couple, counted as household income after deductions.14 QMB pays the Part A premium when one applies, the Part B premium, and Medicare coinsurance, deductibles and copays; SLMB and QI-1 pay the Part B premium only.14 Federal law bars Medicare providers, including Medicare Advantage providers, from billing a QMB enrollee for Medicare Part A and Part B cost-sharing.8

Anyone whose Part B premium is paid through a Medicare Savings Program also gets Extra Help with Part D drug costs automatically.8 A partial-benefit dual eligible can't use the Integrated Care Special Enrollment Period but can use the monthly Dual/LIS window.6 Our guide to Arizona Medicare Savings Programs covers every tier and how to apply.

Keeping Your D-SNP Through an AHCCCS Renewal

Your D-SNP, and for an ALTCS member the FIDE D-SNP tied to your ALTCS plan, depends on your AHCCCS eligibility, so a missed renewal can put both plans at risk. When a special needs plan expects a member who lost eligibility to requalify within six months, federal rules treat that member as still eligible for a period the plan chooses, from one to six months, and the plan should send a disenrollment notice at least 30 days before ending coverage.15 Ask your D-SNP how long its period is, and renew AHCCCS on time. Our guide to Arizona Medicaid recertification and renewal covers the renewal steps and deadlines.

Your Arizona D-SNP in 2027

If your Arizona D-SNP is an applicable integrated plan, as every Arizona FIDE D-SNP was in 2026, its 2027 member handbook and member ID card are built on CMS's integrated model materials: Arizona is one of 23 states and territories whose applicable integrated plan D-SNPs use them for contract year 2027.16,2

If you're in an ACC, ACC-RBHA or DDD plan, a federal rule starting in 2027 may affect which D-SNP will take you. Where a D-SNP's company, its parent or a sister company also runs a Medicaid managed care plan for full-benefit dual eligibles in the same area, that D-SNP must limit new enrollment to people in, or enrolling in, that Medicaid plan; from 2030 it may only enroll or keep those members, and existing members who aren't aligned can stay until 2030.17 The contract year 2027 rule added a fee-for-service exception: where a state doesn't require Medicaid managed care for all full-benefit dual eligibles and the state contract allows it, the company may enroll full-benefit dual eligibles in Medicaid fee-for-service into a coordination-only or HIDE D-SNP.17 Ask Arizona SHIP whether these limits affect the plan you're in or considering.

Before You Change Either Plan, Call Arizona SHIP

In Arizona, a change to your Medicaid plan can ripple into your Medicare plan, so it's worth a free second opinion before you switch either one. Arizona SHIP (the State Health Insurance Assistance Program) is run by the Arizona Department of Economic Security (DES) Division of Aging and Adult Services and gives free health benefits counseling to Medicare beneficiaries. The program is federally funded and not affiliated with the insurance industry. Call the Arizona SHIP confidential helpline at 1-800-432-4040.7 Medicare's own line, 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048), answers 24 hours a day, 7 days a week, except some federal holidays.18 Our Arizona SHIP guide explains what a counselor can do for you.

Learn More

Find personalized help choosing an Arizona D-SNP alongside your ALTCS or AHCCCS plan at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.