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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.

Dual Eligible Financial Alignment Demonstration Enrollment by State,
March 2018 to August 2018
State Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18
California 111,993 110,975 111,225 111,403 111,387 111,549
Illinois 51,699 54,605 54,315 52,685 52,987 54,132
Massachusetts 18,629 20,244 20,297 20,261 20,930 20,930
Michigan 38,562 37,798 39,021 38,327 37,518 37,103
New York 4,037 3,969 3,927 3,895 3,858 3,797
New York – IDD 796 818 888 941 1,013 1,048
Ohio 75,153 74,342 74,274 74,812 74,454 74,556
Rhode Island 13,559 13,441 13,286 13,250 13,126 13,063
South Carolina 11,397 11,337 11,284 11,340 11,186 11,186
Texas 44,099 44,017 42,923 41,707 41,240 41,368
Total Duals Demo Enrollment 369,924 371,546 371,440 368,621 367,699 368,732
Source: State-Reported Enrollment Data; CMS Medicare Advantage Enrollment Data
Massachusetts and South Carolina August 2018 enrollment was not available. July 2018 enrollment was used for the current month.

 

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 Eligible Financial Alignment Demonstration Enrollment Timing; Current and Potential Enrollment – As of August 2018
  Opt-In
Enrollment Date
First Passive
Enrollment Date
Current
Enrollment
Potential
Enrollment
% Enrolled
(Full Potential)
California 4/1/2014 5/1/2014 111,549 350,000 31.9%
Illinois 4/1/2014 6/1/2014 54,132 136,000 39.8%
Massachusetts 10/1/2013 1/1/2014 20,930 100,300 20.9%
Michigan 3/1/2015 5/1/2015 37,103 100,000 37.1%
New York 1/1/2015 4/1/2015 3,797 124,000 3.1%
New York – IDD 4/1/2016 No Passive 1,048 20,000 5.2%
Ohio 5/1/2014 1/1/2015 74,556 114,000 65.4%
Rhode Island 7/1/2016 10/1/2016 13,126 25,400 51.7%
South Carolina 2/1/2015 4/1/2016 11,186 56,600 19.8%
Texas 3/1/2015 4/1/2015 41,368 168,000 24.6%
Total (All States)     400,626 1,254,200 31.9%
Source: State-Reported Enrollment Data; CMS Medicare Advantage Enrollment Data
Massachusetts and South Carolina enrollment as of July 2018.

 

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.

Dual Eligible Financial Alignment Demonstration Enrollment by Publicly Traded Health Plan,
March 2018 to August 2018
Health Plan Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18
Molina 55,117 54,462 54,016 53,805 53,303 53,298
Centene 48,592 48,401 48,196 47,408 47,052 47,073
Aetna 29,954 30,266 30,782 30,116 30,109 30,140
United 20,204 20,022 19,754 19,594 19,400 19,453
Anthem 16,816 16,791 16,472 16,107 15,972 15,902
Humana 7,713 8,401 8,156 7,858 7,686 7,896
CIGNA/HealthSpring 2,104 2,093 2,033 1,979 1,979 2,006
Total Publicly Traded Plans 180,500 180,436 179,409 176,867 175,501 175,768
Source: State-Reported Enrollment Data; CMS Medicare Advantage Enrollment Data

 

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.

Dual Eligible Financial Alignment Demonstration Enrollment by Local/Other Plans,
March 2018 to August 2018
Health Plan Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18
Inland Empire (CA) 24,599 24,459 24,646 24,872 25,091 25,344
BCBS of Illinois (HCSC) (IL) 18,674 19,369 19,574 19,461 19,584 19,921
CareSource (OH) 18,537 18,434 18,478 18,574 18,554 18,573
Commonwealth Care Alliance (MA) 15,835 17,481 17,577 17,593 18,310 18,310
LA Care (CA) 14,979 14,936 15,022 15,189 15,309 15,450
CalOptima (CA) 14,617 14,527 14,533 14,535 14,409 14,386
Neighborhood Health Plan (RI) 13,559 13,441 13,286 13,250 13,126 13,063
Meridian Health Plan (IL, MI) 12,892 13,351 13,176 12,817 12,762 12,960
CareAdvantage (CA) 9,010 8,914 8,951 8,926 8,940 8,921
AmeriHealth Caritas (MI, SC) 8,376 8,240 8,389 8,289 8,098 8,043
Santa Clara Family Health Plan (CA) 7,100 7,037 7,087 7,147 7,170 7,222
CommuniCare Advantage (CA) 5,602 5,643 5,716 5,766 5,785 5,820
Care 1st (CA) 5,356 5,272 5,231 5,206 5,171 5,146
HAP Midwest Health Plan (MI) 4,889 4,768 4,950 4,848 4,733 4,718
Upper Peninsula Health Plan (MI) 4,275 4,249 4,453 4,371 4,284 4,256
CareMore (CA) 3,497 3,439 3,427 3,406 3,381 3,366
Tufts (MA) 2,794 2,763 2,720 2,668 2,620 2,620
VNS Choice (NY) 1,414 1,386 1,357 1,342 1,321 1,278
Partners Health Plan – IDD (NY) 796 818 888 941 1,013 1,048
HealthFirst (NY) 1,018 1,015 1,011 1,007 1,002 998
Elderplan (NY) 485 474 464 462 455 449
GuildNet (NY) 441 435 435 427 430 417
AgeWell New York (NY) 254 245 241 243 245 249
MetroPlus Health Plan (NY) 207 199 200 202 206 209
Senior Whole Health (NY) 142 142 148 146 136 131
Centers Plan for Healthy Living (NY) 34 31 29 28 28 25
Village Senior Services Corp. (NY) 21 21 22 20 19 23
Elderserve Health (NY) 21 21 20 18 16 18
Total Local/Other Plans 189,424 191,110 192,031 191,754 192,198 192,964
Source: State-Reported Enrollment Data; CMS Medicare Advantage Enrollment Data

 

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