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 |
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| 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 |
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| 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 |
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| 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 | ||||||