Enticing Dually Eligible Beneficiaries to Enroll in Integrated Medicare–Medicaid Plans

In 2018, nearly five years after the launch of a federal demonstration program designed to integrate care for people who are dually eligible for both Medicare and Medicaid, the participation rate was stuck at about 30%. Through the program, 10 states and the Centers for Medicare and Medicaid Services contracted with integrated Medicare–Medicaid plans to provide and coordinate benefits. Enrollment in integrated health plans among eligible beneficiaries ranged from a high of 67% in Ohio to a low of 4% in New York.

To discover the secrets to successful enrollment in states like Ohio, Mathematica conducted a study with support from the Medicaid and CHIP Payment and Access Commission. In a new Milbank Memorial Fund issue brief, researchers Debra J. Lipson and Erin Weir Lakhmani share findings from their examination of how state program design, concurrent state programs and policies, health plan markets, and other factors affected enrollment over time in all 10 states. The brief looks closely at two factors associated with higher enrollment: passive enrollment and alignment with existing Medicaid long-term services and supports programs.