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Dual Eligible Financial Alignment Demonstration Enrollment Updated

This week, our In Focus section reviews publicly available data on enrollment in capitated financial and administrative alignment demonstrations (“Duals Demonstrations”) for individuals dually eligible for Medicare and Medicaid (dual eligibles) 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 dual eligibles 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 February 2021, approximately 392,000 dual eligibles were enrolled in an MMP. Enrollment rose 5.7 percent from February of the previous year.

Note on Enrollment Data

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

MMP 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 February 2021, approximately 392,000 dual eligibles were enrolled in an MMP across the nine states below. Since February 2020, enrollment in Dual Demonstrations across all states was up 21,241, a 5.7 percent year-over-year increase.

So far, enrollment in these nine states represents 35.4 percent of the potential enrollment of more than 1.1 million dual eligibles across all nine capitated demonstrations. Participation rates range from a low of about 9 percent in New York’s IDD program to 54.4 percent in Ohio.

Dual Demonstration Enrollment by Health Plan

As of February 2021, half (50 percent) of all dual eligibles in the demonstrations are enrolled in a publicly traded MMP. In February 2020, publicly traded plans represented 51 percent of all duals. Molina and Centene are the largest in terms of enrollment with approximately 59,000 demonstration enrollees in each state.

Among non-publicly traded health plans, Inland Empire in California is the largest, with about 30,000 members, making it the fourth largest MMP nationwide. Commonwealth Care Alliance (Massachusetts), Blue Cross Blue Shield of Illinois (Illinois), CareSource (Ohio), LA Care (California), CalOptima (California), Neighborhood Health Plan (Massachusetts, Rhode Island), and AmeriHealth Caritas (Michigan, South Carolina) all have more than 10,000 enrolled members as of February 2021. Enrollment by non-publicly traded health plans for the past six months is detailed below.