Where should duals-focused sales teams and community partnerships deploy?

Q: Where should duals-focused sales teams and community partnerships deploy?

Texas has 185K duals without a D-SNP available, the largest deployment gap of 30 tracked states. Where duals density and product gaps intersect, ranked for sales deployment. Duals selling is ground-game selling: community health workers, county agencies, food banks, churches, and brokers who work the same zip codes year round. The deployment logic is uncovered duals first, because members with no D-SNP available today are won by whoever shows up with the first product and a familiar face. And because duals hold a recurring SEP, these teams produce enrollment every month, not just during AEP.

Data through June 2026 (duals) · CY2027 Landscape · Updated October 1, 2026 Derived

For plan year 2027, 192,040 dual-eligible people live in counties where no D-SNP is offered, and 3,390,214 live in counties with no HIDE or FIDE (integrated) D-SNP. California has the most duals without an integrated option (916,125). Dual-eligible and LIS beneficiaries do not have an open door every month. Their monthly special enrollment period is limited: it can be used to enroll in an integrated D-SNP (FIDE, HIDE or applicable integrated plan) or to leave Medicare Advantage for Original Medicare with a stand-alone Part D plan (42 CFR 423.38). Other changes wait for AEP or the MA Open Enrollment Period.

Rebuilt October 1, 2026 from June 2026 county dual counts and the CY2027 Landscape. The earlier ranking (“185K uncovered duals in Texas”, 2025 Q4) came from a curated extract and is archived in Methodology.

192.0K

Duals in counties with no 2027 D-SNP

June 2026 duals × CY2027 Landscape

3.39M

Duals in counties with no HIDE or FIDE D-SNP

CMS integration status, CY2027 Landscape

Jurisdictions with no FIDE D-SNP offered for 2027

Duals without an integrated D-SNP in their county, by state (top 12)

Bar: duals in counties with no HIDE or FIDE D-SNP for 2027. Sub-label: duals in counties with no D-SNP of any kind.

Full deployment table: every state

State	Duals (county records)	In counties with no D-SNP	In counties with no HIDE/FIDE D-SNP	Counties with no D-SNP	FIDE offered
California	1,777,831	71,017	916,125	17	Yes
Georgia	372,429	0	372,429	0	No
North Carolina	356,528	0	356,528	0	No
Alabama	219,633	0	219,633	0	No
Missouri	182,683	0	182,683	0	No
Michigan	331,060	0	180,592	0	No
Mississippi	160,836	0	160,836	0	No
Maryland	154,898	0	154,898	0	No
Arkansas	129,090	0	129,090	0	No
Oklahoma	115,942	0	115,942	0	No
Colorado	125,213	0	115,312	0	No
Maine	105,511	0	105,511	0	No
Nevada	83,334	734	83,334	3	No
West Virginia	82,457	0	82,457	0	No
Utah	38,917	0	38,917	0	No
Vermont	31,609	31,609	31,609	14	No
New Hampshire	30,310	30,310	30,310	10	No
Montana	23,976	2,163	23,976	18	No
Oregon	168,032	21,755	21,755	16	No
South Dakota	19,701	1,689	19,701	17	No
Alaska	18,508	18,508	18,508	29	No
North Dakota	14,361	1,794	14,361	23	No
Wyoming	11,782	11,782	11,782	23	No
New York	1,158,947	0	3,246	0	Yes
U.S. Virgin Islands	355	355	355	3	No
Nebraska	43,874	324	324	3	No
Arizona	248,655	0	0	0	Yes
District of Columbia	33,552	0	0	0	No
Delaware	32,467	0	0	0	No
Florida	916,719	0	0	0	Yes
Hawaii	46,970	0	0	0	Yes
Iowa	84,741	0	0	0	No
Idaho	52,377	0	0	0	Yes
Illinois	383,012	0	0	0	Yes
Indiana	219,658	0	0	0	Yes
Kansas	67,761	0	0	0	No
Kentucky	178,433	0	0	0	No
Louisiana	219,440	0	0	0	No
Massachusetts	372,663	0	0	0	Yes
Minnesota	135,302	0	0	0	Yes
New Jersey	231,493	0	0	0	Yes
New Mexico	45,875	0	0	0	Yes
Ohio	405,484	0	0	0	Yes
Pennsylvania	468,248	0	0	0	No
Puerto Rico	5,412	0	0	0	No
Rhode Island	44,569	0	0	0	Yes
South Carolina	172,619	0	0	0	No
Tennessee	233,090	0	0	0	Yes
Texas	668,774	0	0	0	Yes
Virginia	200,923	0	0	0	Yes
Washington	235,838	0	0	0	No
Wisconsin	175,792	0	0	0	Yes

Counties with the most duals and no 2027 D-SNP

County	Duals	Full-benefit duals
Butte County, CA	12,384	12,322
Shasta County, CA	11,713	11,647
Hillsborough County, NH	8,650	5,427
Humboldt County, CA	8,017	7,991
Anchorage Municipality, AK	7,571	7,209
Mendocino County, CA	6,440	6,412
Chittenden County, VT	5,844	3,984
Lake County, CA	5,750	5,730
Sutter County, CA	5,686	5,662
Rockingham County, NH	4,723	3,080
Coos County, OR	4,630	2,307
Nevada County, CA	4,305	4,278
Merrimack County, NH	4,136	2,863
Tehama County, CA	3,994	3,975
Rutland County, VT	3,972	2,448
Yamhill County, OR	3,758	2,040
Umatilla County, OR	3,532	1,843
Siskiyou County, CA	3,399	3,369
Strafford County, NH	3,080	1,655
Windsor County, VT	2,801	1,562
Washington County, VT	2,739	1,532
Windham County, VT	2,627	1,470
Matanuska-Susitna Borough, AK	2,625	2,411
Franklin County, VT	2,430	1,390
Laramie County, WY	2,260	1,326

Every county (CSV), with D-SNP counts by integration status for 2026 and 2027.

Related analysis

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Citation: MedicareInsights. “Where should duals-focused sales teams and community partnerships deploy?.” CMS Medicare Monthly Enrollment June 2026 and CMS CY2027 Landscape, data through June 2026. https://medicareinsights.org/sales/dsnp-deployment/.

Provenance — D-SNP availability by county, plan year 2027

Source file: CMS Medicare Monthly Enrollment, June 2026 (DUAL_TOT_BENES); CMS CY2027 MA & Part D Landscape 202610 (D-SNP integration status)
Vintage: June 2026 duals; CY2027 Landscape
Last updated: October 1, 2026
Method: County duals summed by whether the county has any 2027 D-SNP, and any HIDE or FIDE D-SNP, in the CY2027 Landscape. Script: tools/aep27_dsnp_availability.py.
Known limitations: Availability, not eligibility: a D-SNP may restrict enrollment (for example to full-benefit duals). Connecticut cannot be joined at county level. Enrollment rules: 42 CFR 423.38.