Briefs & Reports

Duals in Medicaid HMOs

There were 53,736 Medicaid beneficiaries dually eligible for Medicare (duals) enrolled in Medicaid HMOs to receive their Medicaid benefits in May 2015, a decrease of 2,848 since April. This reduction may in part be due to implementation of Michigan’s dual eligibles pilot program. Some individuals have transitioned to enrollment in one of the state’s Integrated Care Organizations (ICO). Others that are eligible for enrollment in an ICO have opted out of the demonstration and thereafter receive their Medicaid services on a fee for service basis. (See the Integrated Care for Dual Eligibles article in this newsletter for more information.) All Medicaid HMOs have duals enrolled, although the numbers vary dramatically across plans.

A Medicaid HMO member who gains Medicare coverage and remains in the HMO is categorized as auto-assigned or voluntarily enrolled based on the means through which the member was initially enrolled in the HMO. Duals enrolled in a Medicare Advantage Special Needs Plan (SNP, or D-SNP) for their Medicare benefits but receiving Medicaid on a fee-for-service basis are auto-assigned to the related Medicaid HMO if applicable. Any dual is able to “opt out” of the HMO and receive Medicaid benefits on a fee-for-service basis.

Molina Healthcare of Michigan has the most duals receiving Medicaid services from an HMO, 25.2 percent of the total; Meridian Health Plan of Michigan has 18.9 percent of the total (but the most voluntary enrollees); UnitedHealthcare Community Plan has 17.9 percent of the total; and the other 10 plans share the remaining 38.0 percent.

Six of the 13 Medicaid HMOs in Michigan (or their parent organizations) are also federally contracted as D-SNPs to provide Medicare benefits for duals in Michigan: HAP Midwest Health Plan, HealthPlus Partners, Meridian Health Plan of Michigan, Molina Healthcare of Michigan, Total Health Care, and Upper Peninsula Health Plan. As of May 1, 2015 these six D-SNPs had a combined enrollment of 18,010 duals for whom they provide Medicare services; 71.4 percent of the duals enrolled in a D-SNP are enrolled in the Molina plan, 11.4 percent are enrolled in the Meridian plan (although some of the members may reside in northern Ohio) and the remaining 17.2 percent are spread across the other four plans. Not all of the duals enrolled in these D-SNPs are eligible to receive full Medicaid benefits. Some only receive assistance from the Medicaid program with Medicare coinsurance and deductible payments and/or monthly Medicare premiums.

There is one additional D-SNP in Michigan, Fidelis SecureCare of Michigan, Inc., which does not hold a Medicaid HMO contract but has been approved by the state as an Integrated Care Organization in the state’s duals demonstration. As of May 1, 2015, Fidelis had 1,150 enrollees in its D-SNP. It is also an approved Medicare Advantage Institutional SNP (I-SNP) with 232 enrollees.

Two of the Medicaid HMOs – McLaren Health Plan and UnitedHealthcare Community Plan – discontinued their D-SNP products as of December 31, 2014.

For more information, contact Esther Reagan, Senior Consultant, at (517) 482-9236.