Why Dually Eligible Beneficiaries Stay or Leave Integrated Care Plans

Why Dually Eligible Beneficiaries Stay or Leave Integrated Care Plans

New Mathematica Study of Disenrollment from Dual-Eligible Special Needs Plans
Feb 10, 2021
Sign that says Should I Stay? Should I Go?

With support from Arnold Ventures, Mathematica explored why dually eligible individuals—people who are eligible for both Medicare and Medicaid—leave Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs). Mathematica’s study focused on disenrollment patterns in Medicare Advantage plans that have a majority of D-SNP members. These plans varied in the range of Medicaid benefits covered. The study team tested the association between disenrollment and (1) clinical care quality measures, (2) member experience scores, and (3) level of Medicaid integration. The team also interviewed key stakeholders to explore the effect of other factors on disenrollment patterns within and across states.

The study revealed that myriad factors affect disenrollment including state Medicaid policies and programs and competitive forces in the local market. And because dually eligible beneficiaries are a diverse group, the factors driving their decisions to disenroll vary by their characteristics, including their health conditions, need for long-term services and supports, and full- or partial-benefit dual status. A key lesson from the study is that one of the best ways to retain members is to ensure that they enroll in highly integrated, high quality, member-centric plans from the start.

An issue brief and blog post summarize key findings and draw implications for federal and state policymakers who seek to increase enrollment and retention in integrated care plans. For more background and detailed results, see the full report.

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