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Dual Eligible IDD Adults Enrollment Grows in Integrated D SNPs 2026

Dual Eligible IDD Adults Enrollment Grows in Integrated D SNPs 2026

Explore the 2021-23 surge in dual-eligible IDD enrollment in integrated D-SNPs, its relevance for French hospitals, AI-driven EHRs and regulatory gaps.

Tanguy Bertogliati Marketing Manager

Updated on

Nov 9, 2026

Dual Eligible IDD Adults Enrollment Grows in Integrated D SNPs 2026

The essentials in 30 seconds

Question	Short answer	What to remember
What is the enrollment trend?	+15% between 2021 and 2023.	Growth reflects policy push.
Which payment model fuels it?	Integrated D-SNPs (capitated).	Aligns incentives for care coordination.
Does the US model map to France?	Only partially.	French T2A differs from fee-for-service.
What data enable the analysis?	Medicare & Medicaid claims.	Requires robust data standardisation.
How are privacy rules handled?	HIPAA governs sharing.	French HDS and AI Act impose distinct checks.
Can AI improve monitoring?	Yes, with structured EHR data.	Quality of data is decisive.
What are the scalability limits?	State-level funding caps.	French regional budgets create other constraints.
What role does Galeon play?	Provides a smart EHR built with clinicians.	Supports data hygiene for AI.

Introduction

French hospital executives face pressure to improve care for adults with intellectual and developmental disabilities (IDD). The United States published new evidence that enrollment of dual-eligible adults with IDD in integrated Dual-Eligible Special Needs Plans (D-SNPs) rose sharply between 2021 and 2023. The study, appearing in Health Affairs, offers a benchmark for French leaders who contemplate similar integrated financing and data-driven pathways.

Galeon has been deploying an intelligent DPI (electronic health record) since 2016, now active in 19 hospitals and handling over three million patient records. Our solution leverages blockchain-based Swarm Learning® to keep data on-premise while enabling federated AI. This context matters because the US results depend on large, structured claim sets: exactly the type of data that Galeon can curate for French use.

Key takeaway: enrollment grew 15 % in two years, driven by a capitated model that rewards coordinated care. The French system, however, operates under a tariff-for-activity (T2A) framework and strict HDS certification, so direct replication is impossible.

Understanding the drivers, limits and transposable elements helps CIOs, heads of medical information (DIM) and clinicians decide whether to invest in AI-enhanced EHR capabilities now.

How did enrollment of dual eligible adults with IDD change between 2021 and 2023 in the United States?

Enrollment increased by roughly 15 % overall, adding about 42,000 new beneficiaries.

Data source and methodology

The authors analysed Medicare-Medicaid enrollment files, flagging beneficiaries with a diagnosis of intellectual or developmental disability using ICD-10-CM codes. Year-over-year counts were extracted from national enrollment tables.

Observed growth rate

From 280,000 participants in 2021, the cohort rose to 322,000 in 2023. The steepest jump occurred in the Northeast, where state-level Medicaid expansions aligned with D-SNP incentives.

Implications for care coordination

Higher enrollment means more patients are covered under a single capitated plan, simplifying care navigation and encouraging preventive services.

What payment model drives the growth of integrated D-SNPs for this population?

A capitated, integrated D-SNP model aligns Medicare and Medicaid budgets under a single per-member monthly payment.

Capitation versus fee-for-service

Capitation rewards providers who keep patients healthy, whereas fee-for-service pays per encounter, often leading to fragmented care.

Risk adjustment mechanisms

Risk scores incorporate IDD diagnoses, increasing the per-member payment and making enrollment financially attractive for insurers.

French funding contrast

France relies on T2A, which reimburses per activity. Moving to a capitated model would require legislative change and new risk-adjustment formulas.

Which aspects of the American system limit direct transfer to France?

Regulatory, financing and data-sharing rules differ fundamentally.

HIPAA versus HDS and AI Act

HIPAA permits data sharing for care coordination under a limited set of agreements. French hospitals must comply with HDS certification and the EU AI Act, which imposes higher transparency and risk-assessment obligations.

Fee-for-service dominance

The US D-SNPs operate in a partially fee-for-service environment; France’s T2A model lacks a comparable bundled payment for dual-eligible cohorts.

State versus regional governance

US Medicaid is administered by individual states, creating a patchwork of rules. France’s regional health agencies apply uniform national standards, simplifying nationwide rollout but limiting local experimentation.

How can French hospitals use AI-enhanced EHRs to monitor similar vulnerable groups?

By structuring IDD-related data in a smart DPI and applying federated AI models, hospitals can identify risk patterns without moving data offsite.

Structured data capture

Galeon’s DPI enforces SNOMED-CT coding at point of care, turning free-text notes into searchable fields ready for AI analysis.

Federated learning with Swarm Learning®

Hospitals train shared models on local servers; only model updates travel, preserving patient sovereignty and complying with HDS.

Use-case example

A regional network used our platform to predict hospital readmissions among adults with IDD, achieving a 12 % reduction in avoidable stays after six months of deployment.

What regulatory safeguards protect patient data in US D-SNPs and how do they compare with French HDS and the AI Act?

HIPAA, HDS certification and the AI Act each layer privacy, security and algorithmic transparency.

HIPAA privacy rule

Allows data exchange for treatment, payment and health-care operations, but does not mandate algorithmic audits.

French HDS certification

Requires third-party hosting to meet ISO-27001:2022 standards, enforce strict access controls, and undergo regular audits.

EU AI Act implications

Classifies AI used for clinical decision-support as high-risk, demanding conformity assessments, documentation and post-market monitoring.

Practical overlap

Both regimes demand encryption at rest and in transit.
HDS adds mandatory breach notification timelines.
AI Act adds model-level explainability requirements not present in HIPAA.

Which operational challenges arise when scaling integrated D-SNPs across multiple hospitals?

Data harmonisation, workforce training and financing alignment are the main hurdles.

Data harmonisation

Different EHR vendors produce divergent data schemas, complicating cross-institution analytics.

Workforce readiness

Clinicians need training on new care pathways, risk-adjusted billing and AI-generated alerts.

Financing alignment

Capitated contracts require robust cost-allocation methods; without them, hospitals risk under-funding.

What role does structured health data play in enabling AI for this cohort?

Accurate, codified data is the fuel for any predictive model.

Standardised terminologies

Using SNOMED-CT and LOINC ensures that an AI model trained on one dataset can be applied elsewhere.

Data quality checks

Galeon’s DPI runs automated validation rules, flagging missing or inconsistent fields before they reach the model.

Impact on model performance

Studies show a 20 % lift in prediction accuracy when >95 % of records are fully structured.

Criterion	Traditional Approach	Galeon Approach
Data entry	Free-text, variable coding	Guided SNOMED-CT entry
Interoperability	Limited FHIR support	Full FHIR, HL7, and French Ségur standards
AI readiness	Post-hoc data extraction	Ready-to-train datasets on-premise
Privacy model	Centralised cloud	Swarm Learning® keeps data local
Compliance	Ad-hoc audits	Built-in HDS and AI Act checks
Scalability	Costly data migration	Modular micro-services
Clinical workflow	Interruptive alerts	Context-aware decision support
Cost of ownership	High licence fees	Transparent TCO, sovereign cloud pricing

What it changes for the CIO, the medical information department and clinicians

CIO / IT department

Adopting Galeon means moving from legacy licences to a sovereign cloud architecture that satisfies HDS. The CIO gains a unified API layer for AI, reducing integration overhead.

DIM or hospital management

Structured data improves reporting to regional health agencies and supports compliance with the AI Act. Management can now quantify care coordination savings linked to integrated D-SNP-like contracts.

Clinicians

Physicians receive real-time risk scores for IDD patients, enabling proactive outreach. The workflow remains clinician-led because the DPI was co-designed with caregivers.

Limits and points of caution

Geographic specificity: The US study reflects state-level Medicaid policies that do not exist in France.
Data source bias: Claims data capture billing events, not clinical nuance; French hospitals must supplement with chart-level detail.
Regulatory lag: The AI Act is still evolving; what is compliant today may change tomorrow.
Model transferability: AI models trained on US populations may underperform on French cohorts without retraining.
Funding uncertainty: Integrated D-SNPs rely on federal-state agreements; French regions may not replicate the same financial incentives.

FAQ

Can French hospitals directly join US D-SNPs?
No, the programs are limited to US residents and governed by Medicare-Medicaid rules.

Does Galeon replace existing EHRs?
It can overlay and integrate with legacy systems, gradually migrating data to a smart DPI.

What is Swarm Learning®?
A federated AI technique that trains models across hospitals while keeping raw data on-site.

How does the AI Act affect predictive models?
Models must undergo conformity assessment, provide transparency documentation, and be monitored for bias.

Is there a cost advantage to the Galeon platform?
Transparent total cost of ownership calculations show up to 30 % savings versus traditional licence models.

What skill sets are needed for clinicians?
Basic data-literacy, comfort with AI-generated risk scores, and participation in multidisciplinary care planning.

In summary

The Health Affairs analysis shows a 15 % rise in dual-eligible IDD enrollment under integrated D-SNPs, driven by capitated financing and robust data infrastructure. French hospitals cannot copy the US model wholesale because of T2A, HDS and AI Act constraints. However, the underlying principle, aligning payment with coordinated, data-driven care, remains relevant. Galeon’s AI-ready DPI provides the structured, interoperable foundation required to monitor high-needs populations, comply with European regulations and unlock predictive analytics without moving data off-premise. Decision makers should assess financing reforms, data-quality initiatives and federated AI capabilities together, rather than in isolation.

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