Where should duals-focused sales teams and community partnerships deploy?
Texas alone has roughly 185K dual-eligible people with no D-SNP available, the largest deployment gap among 30 tracked states. Because duals hold a recurring SEP, this population is sellable every month of the year: the question is where to put the teams.
Deployment priority: duals without a D-SNP available (top 12)
Uncovered duals = state duals × (100% − D-SNP coverage). Simple arithmetic on the CMS-sourced extract, computed at build; the coverage definition is in the provenance panel.
Full deployment table: tracked states
| Rank | State | Uncovered duals (K) | Duals (K) | Duals % of Medicare | D-SNP coverage | FIDE available |
|---|---|---|---|---|---|---|
| 1 | Texas | 185 | 562 | 15.2% | 67% | Yes |
| 2 | California | 139 | 631 | 13.4% | 78% | Yes |
| 3 | New York | 134 | 744 | 19.8% | 82% | Yes |
| 4 | Florida | 104 | 651 | 16.9% | 84% | Yes |
| 5 | North Carolina | 96 | 234 | 16.1% | 59% | No |
| 6 | Pennsylvania | 86 | 278 | 14.3% | 69% | Yes |
| 7 | Georgia | 76 | 261 | 17.2% | 71% | Yes |
| 8 | Tennessee | 67 | 190 | 18.9% | 65% | Yes |
| 9 | Ohio | 67 | 281 | 15.8% | 76% | Yes |
| 10 | Indiana | 61 | 133 | 14.6% | 54% | No |
| 11 | Michigan | 60 | 206 | 14.9% | 71% | Yes |
| 12 | Illinois | 59 | 218 | 13.9% | 73% | Yes |
| 13 | Alabama | 56 | 144 | 20.6% | 61% | No |
| 14 | Virginia | 55 | 152 | 12.8% | 64% | No |
| 15 | South Carolina | 52 | 123 | 17.8% | 58% | No |
| 16 | Kentucky | 45 | 119 | 18.4% | 62% | No |
| 17 | Missouri | 45 | 116 | 13.2% | 61% | No |
| 18 | Louisiana | 41 | 148 | 22.1% | 72% | Yes |
| 19 | Mississippi | 37 | 116 | 24.8% | 68% | No |
| 20 | New Jersey | 33 | 130 | 12.1% | 75% | Yes |
| 21 | Washington | 32 | 110 | 10.4% | 71% | Yes |
| 22 | West Virginia | 30 | 71 | 21.4% | 58% | No |
| 23 | Wisconsin | 29 | 81 | 9.8% | 64% | Yes |
| 24 | Minnesota | 25 | 81 | 10.1% | 69% | Yes |
| 25 | Arizona | 24 | 133 | 12.4% | 82% | Yes |
| 26 | Arkansas | 23 | 88 | 20.2% | 74% | No |
| 27 | Massachusetts | 21 | 93 | 9.4% | 77% | Yes |
| 28 | Oregon | 21 | 66 | 9.1% | 68% | Yes |
| 29 | Colorado | 10 | 82 | 10.8% | 88% | Yes |
| 30 | District of Columbia | 1 | 14 | 19.2% | 91% | Yes |
Where duals-led growth is already underway: tracked counties
Counties with a D-SNP share of MA at 20% or higher and positive velocity: the ground game is already converting duals here, so entry means displacing, not pioneering.
| County | State | D-SNP share of MA | Penetration | Velocity (pts YoY) | Carriers | Top carrier |
|---|---|---|---|---|---|---|
| Bronx | NY | 38% | 63.4% | +0.87 | 5 | Centene |
| Kings | NY | 33% | 58.4% | +0.87 | 6 | Centene |
| Philadelphia | PA | 32% | 62.1% | +0.9 | 6 | Centene |
| Miami-Dade | FL | 31% | 74.2% | +1.35 | 8 | UHC |
| Richmond | GA | 31% | 58.2% | +0.87 | 3 | Centene |
| New York | NY | 29% | 56.9% | +0.83 | 6 | UHC |
| El Paso | TX | 28% | 62.8% | +0.93 | 4 | Centene |
| DeKalb | GA | 28% | 56.4% | +0.87 | 4 | Centene |
| Queens | NY | 27% | 61.2% | +0.87 | 5 | UHC |
| Lucas | OH | 26% | 58.1% | +0.9 | 4 | Centene |
| Greene | NC | 26% | 44.8% | +0.87 | 2 | Centene |
| Wayne | MI | 26% | 57.4% | +0.87 | 5 | Centene |
| Broward | FL | 24% | 71.8% | +1.2 | 7 | Humana |
| Cuyahoga | OH | 24% | 57.2% | +0.87 | 5 | UHC |
| Coconino | AZ | 24% | 52.6% | +0.87 | 2 | UHC |
County coverage is the 76-county tracked set (Plan year 2026, with 2023–2026 penetration history). The product-strategy view of the same intersection lives on dual-eligible density.
So what / Now what
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.
- Deploy field teams in rank order of the uncovered-duals column: that is the population no incumbent D-SNP is serving today.
- Stand up community partnerships before product launch; in low-coverage states the trusted-messenger network is the distribution channel.
- Check the FIDE column when sequencing entries: states without FIDE infrastructure carry heavier Medicaid-integration lift for a new D-SNP.
- Use the county table to place teams inside a state: high D-SNP share plus positive velocity marks duals-led growth already underway.
Provenance — Dual-eligible density by state
- Source file
- CMS Medicare-Medicaid dual enrollment data (MMCO quarterly)
- Vintage
- 2025 Q4
- Last updated
- March 15, 2026
- Refresh cadence
- Quarterly (pipeline pending; currently a curated extract)
- Method
- Duals as % of state Medicare population; D-SNP coverage % = share of duals in a county with ≥1 D-SNP available.
- Known limitations
- State-level only; FIDE availability flag is binary and does not reflect county variation.