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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 May 2019, approximately 372,600 duals were enrolled in an MMP. Enrollment was flat from May of the previous year.

Note on Enrollment Data

Seven of the nine states (California, Illinois, Massachusetts, Michigan, New York, Ohio, and South Carolina) report monthly on enrollment in their Dual Demonstration plans, although there is occasionally a lag in the published data. The other states publish intermittent enrollment reports.

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. For Ohio, CMS data was used over the self-reported state data.

Dual Demonstration Enrollment Overview

As of May 2019, approximately 372,600 dual eligibles were enrolled in a demonstration plan across the nine states below. Since May 2018, enrollment in Dual Demonstrations across all states was up 1,151, a 0.3 percent year-over-year increase. The New York Fully Integrated Duals Advantage (FIDA) demonstration is slated to end December 31, 2019 and FIDA-IDD December 31, 2020. Four plans have already pulled out this year.

So far, enrollment in these nine states represents 30 percent of the potential enrollment of more than 1.2 million dual eligible beneficiaries across all ten capitated demonstrations. Participation rates range from a low of about 2 percent in New York to nearly 59 percent in Rhode Island.

Dual Demonstration Enrollment by Health Plan

As of May 2019, nearly half (48 percent) of all duals in the demonstrations are enrolled in a publicly traded MMP. In May 2018, publicly traded plans represented 48.3 percent of all duals. Molina and Centene are the largest in terms of enrollment with more than 55,000 and 35,000 demonstration enrollees, respectively.

Among non-publicly traded health plans, Inland Empire in California is the largest, with about 26,500 members, making it the fourth largest MMP nationwide. Commonwealth Care Alliance (Massachusetts), CareSource (Ohio), Blue Cross Blue Shield of Illinois (Illinois), LA Care (California), Neighborhood Health Plan (Rhode Island), CalOptima (California), and Meridian (Illinois and Michigan) all have more than 10,000 enrolled members as of May 2019. Enrollment by non-publicly traded health plans for the past six months is detailed below.

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