Dual Eligible Financial Alignment Demonstration Enrollment Update

This week, our In Focus section reviews publicly available data on enrollment in capitated financial and administrative alignment demonstrations (“Duals Demonstrations”) for beneficiaries dually eligible for Medicare and Medicaid (duals) in nine states: California, Illinois, Massachusetts, Michigan, New York, Ohio, Rhode Island, South Carolina, and Texas. Each of these states has begun either voluntary or passive enrollment of duals into fully integrated plans providing both Medicaid and Medicare benefits (“Medicare-Medicaid Plans,” or “MMPs”) under three-way contracts between the state, the Centers for Medicare & Medicaid Services (CMS), and the MMP. As of August 2018, nearly 369,000 duals were enrolled in an MMP. Enrollment dropped by 6.7 percent from August of the previous year after Virginia’s dual demonstration ended in December.

Note on Enrollment Data

Six of the nine states (California, Illinois, Massachusetts, Michigan, New York, and South Carolina) report monthly on enrollment in their Dual Demonstration plans, although there is occasionally a lag in the published data. Other states publish intermittent enrollment reports. Massachusetts and South Carolina did not have August 2018 enrollment available, so July 2018 was used.

Duals Demonstration plan enrollment is also provided in the CMS Medicare Advantage monthly enrollment reports, which are published around the middle of each month. In the table below, we provide the most current state-reported data, with CMS data supplementing where needed. Historically, we have seen minor inconsistencies between state-reported data and the CMS enrollment report, likely due to discrepancies in the timing of reports.

Dual Demonstration Enrollment Overview

As of August 2018, nearly 369,000 dual eligibles were enrolled in a demonstration plan across the nine states below. Since August 2017, enrollment in Dual Demonstrations across all states was down 26,570, a 6.7 percent year-over-year decrease. Much of this is attributed to Virginia ending its Dual Demonstration program December 31, 2017. Virginia’s program experienced steady declines in enrollment over the six months prior to the close of the program. The remaining members were transitioned to the state’s new managed long-term services and supports program in 2018.

So far, enrollment in these nine states represents nearly 32 percent of the potential enrollment of more than 1.25 million across all ten capitated demonstration states.  Participation rates range from a low of less than 3 percent in New York to more than 65 percent in Ohio.

Dual Demonstration Enrollment by Health Plan

As of August 2018, nearly half (47.7 percent) of all duals in the demonstrations are enrolled in a publicly traded MMP. This is down slightly from 48.8 percent in March 2018. Molina and Centene are the largest in terms of enrollment with more than 53,000 and 47,000 demonstration enrollees, respectively.

Among non-publicly traded health plans, Inland Empire in California is the largest, with over 25,000 members, making it the fourth largest MMP nationwide. Blue Cross Blue Shield of Illinois (Illinois), CareSource (Ohio), Commonwealth Care Alliance (Massachusetts), LA Care (California), CalOptima (California), Neighborhood Health Plan (Rhode Island), and Meridian (Illinois and Michigan) all have more than 10,000 enrolled members as of August 2018. Enrollment by non-publicly traded health plans for the past six months is detailed below.