INTEGRITY for Duals in Rhode Island: What It Is and How to Join (2026)

If your parent was in Neighborhood Health Plan of Rhode Island's INTEGRITY Medicare-Medicaid Plan, that plan ended on December 31, 2025, and INTEGRITY for Duals replaced it on January 1, 2026.1 INTEGRITY for Duals is Rhode Island's only fully integrated dual plan (FIDE-SNP) in 2026, covering Medicare and Medicaid, long-term care included, while EOHHS says the state's other plans for people with both programs pay for Medicare services only.1,2 If you qualify, you can join INTEGRITY for Duals in any month, with coverage starting on the first day of the next month.1

In This Guide

• What Replaced INTEGRITY MMP?
• INTEGRITY for Duals vs Rhode Island's Other Dual Plans
• What "Fully Integrated" Means for You
• Where Your Medicaid Long-Term Care Comes From
• How to Join, Switch or Leave INTEGRITY for Duals
• If You Lose Medicaid While in a Dual Plan
• What 2027 May Bring
• Free Help in Rhode Island
• Frequently Asked Questions
• Learn More

What Replaced INTEGRITY MMP?

For years, Rhode Islanders with both Medicare and Medicaid could join INTEGRITY, a Medicare-Medicaid Plan (MMP) from Neighborhood Health Plan of Rhode Island. The Rhode Island Executive Office of Health and Human Services (EOHHS), the state's Medicaid agency, said in its 2025 transition FAQs that the MMP was a demonstration only meant to last a limited time, and that it would end on December 31, 2025.1

The end date wasn't Rhode Island's choice alone. The Centers for Medicare & Medicaid Services (CMS) ended the federal demonstration behind MMPs through rulemaking it finalized in 2022, let states keep their demonstrations through the end of 2025, and worked with the seven states still running them to move MMP members into integrated D-SNPs effective January 1, 2026.5

EOHHS said Neighborhood's replacement, INTEGRITY for Duals, would begin on January 1, 2026, and that INTEGRITY MMP members would be signed up for it automatically, without a gap in coverage, unless they called to cancel.1 CMS's contract year 2026 integration file confirms the new plan exists: it lists Neighborhood Health Plan of Rhode Island's H7635-001 as Rhode Island's one FIDE plan.1

So if a parent's plan changed in January and nobody in the family chose it, that's why. Staying is still a choice (see How to Join, Switch or Leave).

INTEGRITY for Duals vs Rhode Island's Other Dual Plans

Rhode Island has two kinds of dual eligible special needs plans (D-SNPs), which are Medicare Special Needs Plans for people with both Medicare and Medicaid. EOHHS said that in 2026 Neighborhood is the only Rhode Island plan offering a FIDE-SNP, and INTEGRITY for Duals is the only integrated managed care plan.1 EOHHS said the state's other plans for people with Medicare and Medicaid, from Neighborhood, Blue Cross Blue Shield of Rhode Island and UnitedHealthcare, pay for Medicare services only, while RI Medicaid pays for Medicaid services, including long-term care.1 CMS's 2026 file lists six Rhode Island D-SNP packages as coordination-only.1

The integration levels and the "applicable integrated plan" flags come from CMS's 2026 file, and who pays for what comes from EOHHS and the Rhode Island Department of Human Services.1,3 The appeals and special enrollment period rows follow the federal rules described below.2,6

Nationally, few people with both Medicare and Medicaid are in the most integrated plans. The Medicare Payment Advisory Commission (MedPAC) found that in 2024, 27% of all people with both Medicare and Medicaid were in coordination-only D-SNPs and only 3% were in FIDE SNPs.7

What "Fully Integrated" Means for You

Under federal rules, a FIDE-SNP is a D-SNP run by a single company that holds both a Medicare Advantage contract with CMS and a Medicaid managed care contract with the state. 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 in the plan year), behavioral health, home health, and medical supplies and equipment, to the extent the state's Medicaid program covers them. From 2025 a FIDE-SNP must also run exclusively aligned enrollment, which means its members get their Medicaid through the same company.2

Three practical differences follow:

• One appeals process. FIDE-SNPs are "applicable integrated plans," which combine Medicare and Medicaid grievances and appeals into one integrated process instead of two separate tracks.2 CMS marks Rhode Island's one FIDE package, Neighborhood's H7635-001, an applicable integrated plan, and marks none of the six coordination-only Rhode Island packages as one.1
• Medicare cost-sharing in the Medicaid contract. From plan year 2025, a FIDE-SNP's Medicaid contract must cover Medicare cost-sharing. A $0 monthly premium, if a plan advertises one, is a plan-design feature, not a legal guarantee.2
• Drugs still follow Extra Help. People with full Medicaid get Extra Help automatically, and it caps what they pay per covered drug.8 For 2026, a full-benefit dual eligible who lives in an institution or receives home and community-based services pays $0 per covered drug; one with income at or below 100% of the federal poverty level pays up to $1.60 for a generic and $4.90 for a brand-name drug.2

Where Your Medicaid Long-Term Care Comes From

This is the question that usually decides it for families covering the cost of a nursing home or home care.

The Rhode Island Department of Human Services (DHS) says that if you meet the clinical and financial criteria for Medicaid-funded long-term care, your care is delivered through one of three routes:3

1. Managed long-term care: through INTEGRITY for Duals or through the Program of All-Inclusive Care for the Elderly (PACE).
2. Fee-for-service: you may choose the agency or provider who delivers your services.
3. Self-direction: you and your family buy home and community-based services yourselves, with help building a budget for the services in your plan of care and an agency, called a fiscal intermediary, that helps pay for them.

These three routes are DHS's list.3 CMS's terms for Rhode Island's Section 1115 Medicaid demonstration, approved for 2026 through 2030, say that for people at the highest or high level of care, those with both Medicare and Medicaid receive primary and acute care through Original Medicare, a Medicare Advantage plan, PACE, or other managed fee-for-service.3

Rhode Island's familiar Medicaid health plans work differently for people on Medicare. EOHHS lists Neighborhood, Tufts and United as the managed care plans that Medicaid members who are not also enrolled in Medicare can join, and says a Medicaid member who is on Medicare can choose whether to enroll in managed care or stay in fee-for-service Medicaid, where Medicaid pays providers directly for each service.3

Which plan your parent is in decides who pays for that care, as the comparison table shows. For the financial side of qualifying, see Brevy's guides to Medicaid long-term care in Rhode Island and Rhode Island's home and community-based services waivers.

How to Join, Switch or Leave INTEGRITY for Duals

The monthly special enrollment periods

Federal rules give dual eligibles two monthly special enrollment periods (SEPs), each taking effect on the first day of the next month:6

• The Integrated Care SEP lets a full-benefit dual eligible, once a month, elect a FIDE SNP, a highly integrated D-SNP (HIDE SNP) or an applicable integrated plan, but only to line up their D-SNP with their Medicaid plan. Partial-benefit duals and people with only Extra Help can't use it, and it doesn't reach a coordination-only D-SNP.6 In Rhode Island, CMS lists one FIDE plan, from Neighborhood, and EOHHS says Neighborhood's FIDE-SNP is INTEGRITY for Duals.1
• The Dual/LIS SEP lets full-benefit and partial-benefit duals and Extra Help enrollees, once a month, switch to Original Medicare plus a stand-alone drug plan, or switch between drug plans.6

Neither monthly SEP moves anyone into a non-D-SNP Medicare Advantage plan. CMS says dual eligibles can still choose any Medicare Advantage plan during Medicare's initial, annual open and Medicare Advantage open enrollment periods and other SEPs that apply.6

If you were moved from INTEGRITY MMP and want out

The automatic move described above has already taken effect. To leave now, the Dual/LIS SEP generally lets a member go back to Original Medicare plus a stand-alone drug plan in any month (it isn't open to someone flagged as at risk under a Part D drug management program).6 Before leaving, check where your long-term care would come from afterward (see the DHS routes above), and talk with SHIP.

If You Lose Medicaid While in a Dual Plan

Every D-SNP depends on your Medicaid. When a special needs plan finds you no longer meet its eligibility rules but can reasonably be expected to requalify within six months, federal rules treat you as still eligible for a period the plan chooses: anywhere from one to six months, applied the same way to all its members.9 If you don't requalify in time, the plan should send a disenrollment notice at least 30 days before ending your coverage, and you get a special enrollment period to choose other coverage.9

The simplest protection is not losing Medicaid at renewal. Brevy's guide to keeping Medicaid in Rhode Island covers the paperwork.

What 2027 May Bring

Rhode Island is on CMS's list of 23 states and territories whose applicable integrated plan D-SNPs use joint CMS-state model materials, such as the member handbook, ID card and provider directory, for contract year 2027.10

A federal enrollment rule also starts in 2027. Where a D-SNP's company, or its parent or a sister company, also runs a Medicaid managed care plan for full-benefit dual eligibles in the same area, the D-SNP must limit new enrollment in 2027 to people enrolled in, or enrolling in, that Medicaid plan, and from 2030 may only enroll or keep such people. Existing unaligned members may stay until 2030, and a D-SNP whose company runs no such Medicaid plan in the state is unaffected.11

CMS's frequently asked questions on the 2027 D-SNP aligned enrollment rule, updated in April 2026, describe an exception added for 2027. Under that exception, starting in 2027, where a state does not require all full-benefit dual eligibles to enroll in Medicaid managed care and the state Medicaid agency's contract allows it, a company that also runs a Medicaid managed care plan for full-benefit duals may still enroll full-benefit dual eligibles who get their Medicaid through fee-for-service into its coordination-only D-SNP or HIDE SNP, though not people enrolled in a Medicaid managed care plan run by an unaffiliated company. CMS says the fee-for-service exception to the D-SNP aligned enrollment rule continues in 2030 and beyond unless the state moves to require aligned enrollment through mandatory Medicaid managed care.11

So whether the 2027 limit reaches a given Rhode Island coordination-only plan turns on two things: whether that plan's company, or an affiliate, also runs a Medicaid managed care plan for full-benefit duals in the same area, and, if it does, whether the fee-for-service exception applies under Rhode Island's Medicaid contract. If you're in one and get a letter about 2027, ask the plan or SHIP whether the rule applies to it.

Free Help in Rhode Island

• SHIP: the state's Office of Healthy Aging runs the State Health Insurance Assistance Program, which helps people find the right Medicare coverage at the right cost and helps people with limited income apply for Medicaid and other programs. Call 888-884-8721.4
• ADRC: for help applying for Rhode Island's Medicare Premium Payment program (its Medicare Savings Programs), EOHHS directs people to the ADRC at 401-462-4444.12
• 1-800-MEDICARE: 1-800-633-4227 (TTY 1-877-486-2048), available 24 hours a day, 7 days a week, except some federal holidays. For a plan-specific question, CMS says to call your plan first, using the number on your member ID card.13

For the rest of your Medicare choices in the state, see Medicare Plans and Coverage in Rhode Island, and for how other states handle these plans, Brevy's integrated dual plans by state.

Learn More

Find personalized help choosing a Rhode Island dual eligible 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.