In Virginia, choosing a D-SNP for your Medicare coverage also chooses your Medicaid health plan, because the state moves you into the same company's Cardinal Care plan. A Virginia D-SNP (dual eligible special needs plan) is a Medicare Advantage plan for people who have both Medicare and Medicaid, and the Virginia Department of Medical Assistance Services (DMAS) calls the same-company requirement "exclusively aligned enrollment." Since January 1, 2025, no full-benefit Virginia dual eligible in Medicaid managed care who elects a D-SNP may have a Medicaid plan from a different company.

In This Guide

How Virginia's D-SNP Rule Works

Cardinal Care is Virginia's statewide Medicaid managed care program, which coordinates care for full Medicaid beneficiaries. Virginia ties the Medicare side to that Medicaid plan. DMAS says a Virginia Medicaid member who chooses a D-SNP must also enroll in the Medicaid plan run by the same health insurance company (managed care organization, or MCO) as the D-SNP.

The direction matters. In Virginia, your choice of D-SNP decides your Medicaid plan, not the other way around: DMAS identifies D-SNP members from Medicare enrollment data and auto-enrolls them into the D-SNP company's affiliated Cardinal Care Managed Care (CCMC) plan. In Virginia, a full-benefit Medicaid member who signs up with one company's D-SNP while in another company's Medicaid plan is moved to the D-SNP company's Medicaid plan.

DMAS's 2026 contract for D-SNPs serving full-benefit dual eligibles sets three terms for the D-SNP company:

  • Cardinal Care contract: The D-SNP company must also hold the Cardinal Care Managed Care contract for Virginia Medicaid.
  • Exclusively aligned enrollment: The D-SNP must operate with exclusively aligned enrollment.
  • FIDE SNP status: The D-SNP must meet federal standards for, and be approved by CMS as, a fully integrated dual eligible special needs plan (FIDE SNP), unless DMAS grants the company an exception.

Because of that exception, not every Virginia D-SNP is necessarily a FIDE SNP. The Centers for Medicare & Medicaid Services (CMS) contract year 2026 integration-status file lists Virginia among the states with FIDE SNPs, and also among the states with highly integrated (HIDE) and coordination-only D-SNPs. DMAS also issues a separate 2026 D-SNP contract for partial-benefit dual eligibles. If the plan type matters to you, ask the plan directly which one it is.

Who the Virginia D-SNP Rule Applies To

DMAS describes exclusively aligned enrollment as a D-SNP member who is eligible for full Medicaid coverage getting Medicaid and Medicare benefits from the same company. DMAS's 2024 bulletin announcing the rule names the groups it leaves alone:

Your situation Does the Virginia alignment rule affect you?
Full Medicaid, in a Cardinal Care health plan, and in (or joining) a D-SNP Yes. Your D-SNP and Medicaid plan must be from the same company.
Full Medicaid, but excluded from Medicaid managed care (for example, living in an excluded facility) No
Full Medicaid, with Original Medicare or a Medicare Advantage plan that is not a D-SNP No
Partial-benefit dual eligible (the state helps pay Medicare costs, but you don't get full Medicaid) No. Partial-benefit duals are excluded from Medicaid managed care.

DMAS defines a partial-benefit dual eligible as someone who gets full Medicare and whose income is too high for full Medicaid but low enough that the state pays their Medicare coinsurance and/or deductible. If that describes you, your help comes through one of the Medicare Savings Programs. In Virginia, the 2026 income limit for the Qualified Medicare Beneficiary (QMB) program is $1,350 a month for one person, with a $9,950 resource limit. Our guide to Virginia Medicare Savings Programs has the full table.

What Are Your Options If Your Plans Don't Match?

The hard case is a family that likes its Cardinal Care health plan, often because of a home care agency or care coordinator, and then sees an ad for another company's D-SNP. DMAS's member materials give a Virginia Medicaid member who wants to keep a current Medicaid plan these choices:

What you do Your Medicare coverage Your Cardinal Care (Medicaid) plan
Switch to the D-SNP run by your Medicaid company That company's D-SNP Stays the same
Keep your D-SNP Stays the same Moved to the D-SNP company's Medicaid plan
Leave the D-SNP for Original Medicare plus a Part D drug plan Original Medicare and a separate Part D plan Stays the same
Leave the D-SNP for a Medicare Advantage plan that is not a D-SNP That Medicare Advantage plan Stays the same

Leaving the D-SNP keeps your Medicaid plan, but it can change your extra benefits, and a move to Original Medicare means adding a separate Part D drug plan.

What Can Change When You Switch Plans?

DMAS spells out what a Virginia dual eligible can lose when either plan changes:

  • Your providers: If you change your D-SNP or your Medicaid plan, DMAS says it is not guaranteed that your current providers will be in the new plan's network. DMAS adds that this is especially true for Medicaid-only services such as home and community based services, behavioral health or addiction recovery services, and non-emergency medical transportation.
  • Your care coordinator: A change of D-SNP or Medicaid plan could mean you can no longer work with the care coordinator you know.
  • Your extra benefits: D-SNPs all provide supplemental benefits, but not the same ones, and DMAS says a switch of Medicaid plan or D-SNP could change the extra benefits you get.
  • Your drug coverage: A member who leaves a D-SNP for Original Medicare must also choose and enroll in a Medicare Part D drug plan, because D-SNPs are required to include prescription drug coverage and Original Medicare does not cover prescription drugs.

If a parent gets home care or other waiver services through Medicaid, check the new plan's network for those exact agencies before switching. Our guide to Virginia Medicaid HCBS waivers explains those services.

How to Find the D-SNPs Your Medicaid Company Offers

This guide doesn't list plan names, because we couldn't confirm Virginia's full 2026 D-SNP lineup from a state source. Use these routes instead, all from DMAS's member materials:

  1. Call your Medicaid plan. Ask your Cardinal Care plan's member services whether the company offers a D-SNP where you live.
  2. Search the Medicare Plan Finder. DMAS says you can find the D-SNPs offered by your Medicaid company on the Medicare Plan Finder.
  3. Call VICAP. The Virginia Insurance Counseling and Assistance Program (VICAP) takes questions about Medicare and Medicare Advantage plans, including D-SNPs, at 1-800-552-3402.

To change your Medicaid plan instead, DMAS says you can call Virginia's Managed Care Helpline at 1-800-643-2273 (TTY: 1-800-817-6608) or use its website.

When Can You Change a Virginia D-SNP?

You don't have to wait for fall open enrollment. Two federal special enrollment periods (SEPs) from the contract year 2025 Medicare Advantage and Part D rule apply every month:

  • Integrated care SEP: Once per month, a full-benefit dual eligible can enroll in an integrated D-SNP (fully integrated, highly integrated or applicable integrated plan) to line up with their Medicaid plan.
  • Dual and Extra Help SEP: Once per month, a dual eligible or a person with Extra Help can elect a stand-alone Part D prescription drug plan, except while identified as a potential at-risk or at-risk beneficiary under a Part D drug management program.

DMAS's member FAQ describes the Virginia result of those rules in plain terms: the monthly SEP lets a D-SNP member change plans any time of year, but only two ways, to a D-SNP aligned with the member's Medicaid plan or back to Original Medicare with a Part D drug plan. Our guide to Medicare special enrollment periods covers the others.

What Happens If Your Medicaid Lapses?

A D-SNP is only for people with Medicaid, so losing Medicaid at renewal puts the plan at risk. Under 42 CFR 422.52(d), a special needs plan that finds a member no longer qualifies, but can reasonably expect them to qualify again within six months, must treat the member as still eligible for at least 30 days and no more than six months. CMS's contract year 2027 guidance says the plan picks that length, anywhere from one to six months, as long as it applies the same policy to every member and tells them.

Ask your D-SNP what its period is before you need it, and renew Virginia Medicaid on time. Our guide to Virginia Medicaid recertification and renewal walks through the steps.

What the 2027 and 2030 Federal Rules Mean

A federal rule, 42 CFR 422.514(h), starts limiting D-SNP enrollment nationwide in 2027. CMS's April 2026 questions and answers explain whom it reaches:

  • Starting in 2027: If a D-SNP's company, or a company under the same parent, also runs a Medicaid managed care plan for full dual eligibles in the same service area, that D-SNP may only take new members who are in, or enrolling in, that affiliated Medicaid plan.
  • Starting in 2030: That D-SNP may only enroll or keep members who are also in the affiliated Medicaid plan, and unaligned members are disenrolled.
  • Who is not affected: A D-SNP whose company runs no Medicaid managed care plan for full dual eligibles in the state is outside these limits.

Virginia got there first. Virginia's own rule has required matching plans for full-benefit dual eligibles in a D-SNP since January 1, 2025. CMS also lists Virginia among the 23 states and territories that use its integrated model materials (member handbook, ID card and provider directory) for contract year 2027. How the federal exceptions play out for any one Virginia plan is a question for VICAP or the plan, not something this guide can answer for you.

Where Can You Get Free Help in Virginia?

VICAP is Virginia's State Health Insurance Assistance Program, a free, unbiased and confidential counseling service for people with Medicare and their families. A VICAP call is a sensible step before you join, leave or switch a Virginia D-SNP. See our Virginia VICAP guide for how appointments work.

Question Where to go
Comparing Medicare plans, including D-SNPs VICAP, 1-800-552-3402
Changing your Cardinal Care (Medicaid) plan Managed Care Helpline, 1-800-643-2273 (TTY: 1-800-817-6608)
A problem your Cardinal Care plan won't solve, a denial, or a bill you think the plan should pay Medicaid Managed Care Advocates, 804-663-7821
What a specific D-SNP or Medicaid plan covers The member services number on your plan ID card

DMAS publishes the VICAP and Managed Care Helpline numbers in its D-SNP member materials. The Virginia Department for Aging and Rehabilitative Services says its Medicaid Managed Care Advocates, run by the Office of the State Long-Term Care Ombudsman, help Cardinal Care members with problems their plan hasn't resolved, including denials, grievances and appeals. For a formal appeal on the Medicaid side, see Virginia Medicaid appeals and fair hearings.

Frequently Asked Questions

Can I keep my Cardinal Care plan if I join a different company's D-SNP?

No. A Virginia D-SNP and its member's Cardinal Care plan must come from the same company, so joining another company's D-SNP moves your Medicaid to that company. Before you enroll, check that the doctors and home care agencies you rely on are in that company's network, because DMAS says they are not guaranteed to be.

Can I move to a different Medicaid company and still have a D-SNP?

Yes, but the D-SNP has to come from the new company. DMAS says a Virginia D-SNP member's choice of D-SNP controls which Cardinal Care plan they are in, and no D-SNP member may have a Medicaid plan from a different company. In Virginia, a D-SNP member who wants another company's Medicaid plan and a D-SNP would choose that company's D-SNP, and a member who wants to keep a Medicaid company without its D-SNP can choose Original Medicare with a Part D plan or a Medicare Advantage plan that is not a D-SNP. Talk to VICAP before you change either plan.

Can I switch again if I don't like my new Virginia D-SNP?

Yes, without waiting for fall open enrollment. DMAS describes a monthly special enrollment period that lets a Virginia D-SNP member move, in any month, to a D-SNP aligned with their Medicaid plan or back to Original Medicare with a Part D drug plan.

Does the Virginia D-SNP rule apply if I only get help paying Medicare costs?

No. DMAS says partial-benefit dual eligibles, whose state help covers Medicare costs but who don't get full Medicaid, are excluded from Medicaid managed care and are not affected by the alignment rule. Your help comes through Virginia's Medicare Savings Programs instead.

Learn More

MedicareFully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs) ExplainedFIDE-SNPs are the high-integration dual-eligible plans replacing the MMP demonstration on 1/1/2026: definitions, state landscape, and family pitfalls. MedicareHow Medicare Special Needs Plans WorkMedicare Special Needs Plans restrict enrollment to specific groups. Learn the three types, C-SNP, D-SNP, and I-SNP, who qualifies, and how to enroll in 2026. MedicareMedicare and Medicaid Together: Dual Eligibility ExplainedWhat dual eligible means: how Medicare and Medicaid coordinate, full vs. partial duals, QMB cost protection, automatic Extra Help, and integrated D-SNP plans. MedicareMedicare in Virginia: Plans and CoverageMedicare in Virginia for 2026: Part A and B costs, Medicare Advantage, Part D, SCC-regulated Medigap, Medicare Savings Programs, and free VICAP counseling. MedicaidVirginia Medicaid: A Guide for Seniors and FamiliesVirginia Medicaid (Cardinal Care) covers long-term care through DMAS in 2026: eligibility, spend-down, CCC Plus waiver, MSPs, spousal rules, and how to apply. MedicareIllinois FIDE SNPs: The Dual Medicare-Medicaid Plans That Replaced MMAIMMAI ended Dec. 31, 2025. The Illinois FIDE SNP plans from Aetna, Humana, Molina and Wellcare Meridian: who qualifies, how to switch, and the Medicaid fallback.

Find personalized help deciding whether a Virginia D-SNP fits your Cardinal Care 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.

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