Dual Eligible in Harris County: How Integrated D-SNPs Work With Medicare and Texas Medicaid

For twelve years, a Houston resident with both Medicare and Texas Medicaid who wanted their two programs to work as one had a single option: a Medicare-Medicaid Plan under the state’s Dual Demonstration. That project ended on December 31, 2025.

What replaced it arrived quietly on January 1, 2026. Harris County is now one of five Texas counties where Integrated Dual Eligible Special Needs Plans operate — plans that carry your Medicare and your Medicaid under one roof, with one card, one care coordinator, and one appeals process. Bexar, Dallas, El Paso and Hidalgo counties got them the same day.

Most people who qualify have never heard the term. With the Annual Enrollment Period running October 15 through December 7, this is the year to learn it. Below: who counts as dual eligible in Texas, what the four kinds of D-SNP actually differ on, how the enrollment rules work (they are unusually generous), what changes in 2027, and three Harris County households worked through.

The short answer: a D-SNP is a Medicare Advantage plan built only for people who have both Medicare and Medicaid. In Harris County, two carriers — Molina Healthcare and UnitedHealthcare — offer Integrated D-SNPs as of January 1, 2026, and choosing one automatically enrolls you in that company’s matching STAR+PLUS Medicaid plan. If you are a full-benefit dual, you can switch into an integrated plan once a month rather than waiting for the Annual Enrollment Period. Your Medicaid benefits do not shrink because you joined.

What changed in Harris County on January 1, 2026

Texas ran a Medicare-Medicaid Plan demonstration — the Dual-Eligible Integrated Care Demonstration Project, usually shortened to the Dual Demo — for more than a decade. It was a three-way arrangement among the state, CMS and a handful of health plans, and it covered a limited set of counties. Harris County was one of them.

CMS’s Contract Year 2023 final rule required states to wind those demonstrations down. Texas HHS ended the Dual Demo on December 31, 2025, and the same health plan companies that had been running MMPs began operating Integrated D-SNPs on January 1, 2026.

For a member, the change was mostly administrative — but not entirely. The new structure sits inside Medicare Advantage, which means it follows Medicare Advantage rules for enrollment, marketing, appeals and star ratings. That brings the plan under the same October-to-December calendar everyone else lives by, with one large exception covered below.

If you were in an MMP at the end of 2025, you were moved rather than dropped. That does not mean the plan you landed in is the one that fits you now. A transition is exactly the moment to check.

Who counts as “dual eligible” in Texas

“Dual eligible” is not one category. It is a family of them, and which one you are in decides which plans you can join and how much Medicaid actually pays on your behalf.

The dividing line that matters most is full-benefit versus partial-benefit. Full-benefit duals get Medicare plus the complete Texas Medicaid benefit package. Partial-benefit duals qualify for a Medicare Savings Program that pays some Medicare costs, but not for full Medicaid coverage.

The Part B premium alone is $202.90 a month in 2026, with a $283 annual deductible. For someone living on a fixed income, having Medicaid pay that premium is the difference between affording a plan and not. We walk through the income and asset tests for each program in our guide to Medicare Savings Programs in Texas, and the broader distinction between the two programs on our Medicare vs Medicaid page.

Only full-benefit duals can use the Integrated Care Special Enrollment Period described below. Partial duals have a different, still useful, set of options.

The four kinds of D-SNP, and why the label matters

Every D-SNP is a Medicare Advantage plan limited to people with both programs. Past that, the amount of genuine integration varies enormously — and the marketing rarely makes the difference obvious.

The Applicable Integrated Plan designation is the one worth asking about by name. It came out of the Bipartisan Budget Act of 2018 and obliges the plan to run a single appeals and grievance process across both programs. If you have ever filed an appeal with Medicare and a separate appeal with Medicaid over the same denied service, you already understand why that matters.

So the useful question for an agent or a plan representative is not “is this a D-SNP.” It is: “Is this an Applicable Integrated Plan, and if I appeal a denial, is that one appeal or two?”

What integration actually buys you

The benefit is less about extra services and more about removing friction — the kind that quietly costs people care.

• One plan, one card, one phone number. Choosing an Integrated D-SNP in Harris County automatically enrolls you in that company’s matching STAR+PLUS plan, so both programs sit with the same organization.
• One care coordinator. Rather than a Medicare Advantage case manager and a separate STAR+PLUS service coordinator working from different records, an integrated plan assigns one.
• Unified appeals, in an AIP. One appeal moving through one process instead of two parallel tracks with different deadlines.
• Cost sharing already handled. As a QMB you cannot be billed for Medicare deductibles and coinsurance by a participating provider. Balance billing a QMB is prohibited — a rule that is violated often enough that it is worth knowing.
• Extra benefits typical of Medicare Advantage, such as dental, vision, hearing or transportation allowances, which vary by plan and year.

What integration does not do is expand your Medicaid eligibility or add benefits Texas Medicaid does not cover. It changes who administers them and how the pieces talk to each other. That is worth a great deal, but it is not new coverage.

How enrollment works, and the monthly SEP most people miss

This is where duals have a genuine advantage over everyone else on Medicare — and where a rule change in 2025 caught a lot of people out.

Before 2025, duals and people with the Part D Low-Income Subsidy could change plans once per calendar quarter for the first three quarters of the year. That quarterly SEP sunset on January 1, 2025.

Two narrower SEPs replaced it:

Read the first row carefully, because the limitation is easy to miss. The Integrated Care SEP lets a full-benefit dual join an integrated D-SNP in any month — but only one affiliated with the Medicaid managed care organization they are enrolled in or enrolling into. It exists to let your Medicare follow your Medicaid, not to allow unlimited shopping across every Medicare Advantage plan on the market.

Changes take effect the first day of the following month. Nothing here removes your ordinary rights: you still have the Annual Enrollment Period from October 15 to December 7, and the Medicare Advantage Open Enrollment Period from January 1 to March 31 if you are in an MA plan. Our Houston AEP pre-flight checklist walks through the general timeline.

What changes in 2027 and 2030

CMS is steering the D-SNP market toward tighter alignment between a member’s Medicare plan and their Medicaid plan. Two dates matter.

Beginning in 2027, under 42 C.F.R. § 422.514(h), where a Medicare Advantage organization offers a D-SNP and that organization — or its parent, or a sibling under the same parent — also contracts with the state as a Medicaid managed care organization enrolling full-benefit duals in the same service area, new enrollment provisions apply. Partial overlap of service areas is enough to trigger them. These provisions reach all D-SNP types, including coordination-only plans affiliated with a commonly owned Medicaid contract.

Beginning in 2030, those D-SNPs must generally enroll only people who are enrolled in — or in the process of enrolling in — the affiliated Medicaid plan, with an exception preserving deemed continued eligibility protections.

The direction of travel is clear: your Medicare plan and your Medicaid plan are meant to be two halves of one arrangement. For a Harris County resident, the practical read is that the alignment you choose this year is likely to matter more each year, not less. It is also a reason to be deliberate now rather than to let a default carry you.

A D-SNP must also hold a State Medicaid Agency Contract in place before the contract year begins in order to operate at all. That is a background requirement, but it is why plan availability can shift from one year to the next — and why checking annually is not paranoia.

What happens if you lose Medicaid eligibility

This is the question that worries people most about tying their Medicare to their Medicaid, and it deserves a direct answer.

Texas Medicaid eligibility is redetermined periodically. Income can rise, an asset test can be missed, or — very commonly — paperwork can go unreturned because it went to an old address. If your Medicaid stops, you no longer meet the D-SNP’s eligibility requirement.

Medicare does not drop you the next morning. D-SNPs operate a deemed continued eligibility period: for a defined window set by the plan’s state contract, the plan continues to treat you as eligible while your Medicaid status is sorted out. It is a grace period, not a permanent fix, and the length varies. Notably, the enrollment restrictions arriving in 2030 carry an explicit carve-out preserving these protections — a sign CMS regards them as load-bearing.

Three things follow from that:

• Open the mail. The single most common reason people lose Texas Medicaid is a renewal packet that was never returned. Keep your address current with both Medicaid and your plan.
• Act inside the window. If you get a notice that your Medicaid has ended, that is the moment to call — not after the deemed period runs out. Restoring eligibility during the window is far simpler than re-enrolling after it.
• Know your fallback. If eligibility genuinely ends, you will need a different Medicare arrangement. There is a Special Enrollment Period for losing the dual status that qualified you for the plan, but it is time-limited.

We cover the Medicaid side of this in detail in our guide to losing Texas Medicaid, which deals mainly with under-65 households but explains the redetermination machinery that applies to everyone.

D-SNP versus keeping Original Medicare

An Integrated D-SNP is not automatically the right answer. For some Harris County duals, Original Medicare plus full Medicaid plus a standalone drug plan remains the better fit. The honest comparison:

The trade is real: coordination and extra benefits in exchange for a network and prior authorization. If you see specialists at a particular institution and they are not in the plan’s network, that fact usually outweighs everything else in the table. If you are managing several chronic conditions across multiple providers and nobody is currently connecting them, coordination may be worth more than the flexibility you give up.

Three Harris County households, worked through

1. A full dual in STAR+PLUS, currently in Original Medicare

A 71-year-old in northeast Houston has Medicare and full Texas Medicaid, receives long-term services and supports through STAR+PLUS, and stayed with Original Medicare plus a standalone drug plan out of habit.

She is the clearest candidate for an Integrated D-SNP. She can use the Integrated Care SEP to join an integrated plan affiliated with her STAR+PLUS managed care organization in any month — she does not have to wait for December 7. The thing to check before moving: whether her current doctors participate in the D-SNP’s network, because moving from Original Medicare to a Medicare Advantage plan means moving into a network. That single question decides the case.

2. A partial dual with QMB only

A 68-year-old in Pasadena qualifies for QMB. Medicaid pays his Part B premium and shields him from Medicare deductibles and coinsurance, but he does not have full Texas Medicaid.

He cannot use the Integrated Care SEP, which is limited to full-benefit duals. He may still be eligible for a coordination-only D-SNP, and he can use the monthly Dual/LIS SEP to change his standalone Part D plan. His bigger opportunity is checking whether he qualifies for full Medicaid — that answer changes everything above it. His QMB status also means participating providers may not bill him for Medicare cost sharing, which is worth raising if he has been getting bills.

3. A former Dual Demo member moved automatically in January

A 74-year-old in Aldine was in an MMP through 2025 and was moved into that carrier’s Integrated D-SNP on January 1, 2026. Nothing appeared to break, so she has not looked at it since.

She should read her Annual Notice of Change for 2027 carefully. A transition year is exactly when formularies, networks and supplemental benefits get rewritten. She has two carriers to compare in Harris County, and if she is a full dual, the monthly SEP means she is not trapped if she finds something better in February.

Your checklist before December 7

1. Confirm which dual category you are in. Your Your Texas Benefits letter or the Medicaid office can tell you whether you have full benefits or a Medicare Savings Program only.
2. Find out which STAR+PLUS plan you are in, if any. Integrated D-SNP options are tied to it.
3. Ask whether a plan is an Applicable Integrated Plan, and whether appeals are unified.
4. Check your doctors and hospitals against the plan’s network — in writing, and dated. This is the step people skip and regret.
5. Check every prescription against the 2027 formulary, including tier and any prior authorization.
6. Read the Annual Notice of Change that arrived by September 30 before assuming next year looks like this year.
7. If you are being billed for Medicare cost sharing as a QMB, raise it — participating providers are prohibited from balance billing you.

Frequently asked questions

Talk it through with someone local

Dual eligibility is one of the few areas of Medicare where the right move can be large and the rules genuinely favor you — a monthly enrollment window is a real advantage. It is also an area where the wrong move, particularly a network mismatch, lands hardest on people with the least room to absorb it.

If you have both Medicare and Texas Medicaid and you are not sure what you are enrolled in, that is a normal place to start. Call 832-400-6538 or email sara@wisehealthins.com, or read more about the Medicare plan types we work with. We serve clients from North Houston and South Houston.

Wise Insurance Agency is an independent insurance agency licensed in Texas. We do not offer every plan available in your area. Any information we provide is limited to the plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program for information on all of your options. This article is general information, not medical, legal or tax advice.