Passive Enrollment of Dual-Eligible Beneficiaries Into Medicare and Medicaid Managed Care Has Not Met Expectations

Publication Name: 
Health Affairs
Publication Authors: 
Grabowski DC, Joyce NR, McGuire TG, Frank RG
Date of Publication: 
May 2017

Abstract

The Centers for Medicare and Medicaid Services Financial Alignment Initiative represents the largest effort to date to move beneficiaries who are eligible for both Medicare and Medicaid-known as dual eligibles-into a coordinated care model by the use of passive (automatic) enrollment. Thirteen states are testing integrated payment and delivery demonstration programs in which an estimated 1.3 million dual eligibles are qualified to participate. As of October 2016, passive enrollment had brought over 300,000 dual eligibles into nine capitated programs in eight states. However, program participation levels remained relatively low. Across the eight states, only 26.7 percent of dual eligibles who were qualified to participate were enrolled, ranging from 5.3 percent for the two New York programs together to 62.4 percent in Ohio. Although the exact causes of the high rates of opting out and disenrolling that we observed among passively enrolled dual eligibles are unknown, experience to date suggests that administrative challenges were combined with demand- and supply-side barriers to enrollment. These early findings draw into question whether passive enrollment can encourage dual eligibles to participate in integrated care models.

Project HOPE—The People-to-People Health Foundation, Inc.

KEYWORDS:

Elderly; Managed Care; Medicaid; Medicare; Mental Health/Substance Abuse

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