Payer Pulse
Where the Medicare book and the Medicaid book are the same members.
Report 03: The duals seam / companion to Report 01: Medicare and Report 02: Medicaid
CMS SNP Comprehensive Reports, monthly / August 2023 – July 2026, all 36 months
Centene told investors that dual-eligible members are around 40 percent of its Medicare Advantage book. CMS's files say 39.9 percent. How it got there is the finding.
D-SNP members at July 2026, and each company's D-SNP share of its own Medicare Advantage book
Dual-eligible special needs plans, D-SNPs, are Medicare Advantage plans sold specifically to people who also have Medicaid. They are the seam where this site's first two reports meet: the same person is a Medicare member in Report 01 and a Medicaid member in Report 02. Nearly 6.5 million people are enrolled in one, and half the market belongs to UnitedHealth and Humana.
The verified 40 percent is not a growth story, and saying so plainly matters. Centene's D-SNP book actually shrank 10 percent over these three years. Its share climbed from 32.6 to 39.9 percent because the non-dual rest of its Medicare Advantage book fell 34 percent, more than three times faster, which is the company's stated plan, aligning its Medicare footprint to its Medicaid footprint, carried out in the files. The quiet growth story is elsewhere: CVS nearly doubled its D-SNP book over the same window. The notes take each in turn.
Scope: D-SNP enrollment only. Many dual-eligible people are in ordinary Medicare Advantage plans or original Medicare instead, so this undercounts every company's total dual membership; it measures the product built for duals, not the population. Same four companies as the other reports. One CMS data quirk is disclosed in Panel 01's caveat.
The D-SNP market
Panel 01D-SNP members by parent company, monthly, from CMS's SNP Comprehensive Reports. Contract-to-parent attribution reuses the same per-month mapping as Report 01, so sub-brands roll up identically. The national market grew 16.6 percent across the window, and the four companies' combined share drifted down from 65 to 63 percent as the rest of the market grew faster.
One month reads low by design: October 2023's workbook is internally inconsistent in CMS's own publication, its plan-level sheet running about 2.8 percent under its own summary because it was generated from a stale data pull. Every other month reconciles to CMS's summary exactly. The dip that month is the file, not the market.
Integration depth
Panel 03Not all D-SNPs are equally connected to Medicaid. CMS classifies each as coordination-only (CO), highly integrated (HIDE), or fully integrated (FIDE), by how much of the member's Medicaid benefit the same organization actually manages. The share of each company's D-SNP book in the two integrated tiers, at July 2026, tracks how deep its Medicaid machinery goes: the company with the largest Medicaid book in Report 02 also runs the most integrated D-SNPs here.
Integration status reflects plan design and state contracts, not quality. This panel is the latest month only, by choice rather than necessity: CMS has published these columns since 2022, so the same three years of history exist and a trend could be drawn from them.
Analyst notes
Read alongsideObservations about an industry, not investment advice.