Why Dually Eligible Beneficiaries Stay or Leave Integrated Care Plans
- Three of nine quality and beneficiary experience measures examined were associated with lower rates of disenrollment: higher member ratings of the health plan and flu vaccination rates were associated with fewer members leaving the plan, while more member complaints about the health plan was associated with more members leaving the plan. The other six measures had an association in an unexpected direction or were not associated with disenrollment rates.
- We did not find a statistically significant association between plans’ level of Medicaid integration and disenrollment rates. When we separated the plans by enrollment size and Medicaid integration level, we found associations with disenrollment rates for certain subsets but in opposite directions, suggesting that something else might explain the results.
- Three inter-related sets of factors explain some of the differences in voluntary disenrollment rates across D-SNP dominant MA contracts: (1) state Medicaid policies and programs; (2) local market features and competitive forces; and (3) beneficiary characteristics and preferences.
To reduce costs and improve care outcomes for people who are eligible for both Medicare and Medicaid, federal and state agencies have developed a variety of integrated care models to better coordinate services across the two programs. The model with the largest number of enrollees is a Medicare Advantage plan that limits enrollment to dually eligible beneficiaries and is required to coordinate their Medicaid benefits, known as a Dual Eligible Special Needs Plan (D-SNP). Despite rapid growth in the number of beneficiaries in D-SNPs, and more of these plans becoming available in 2021, voluntary disenrollment rates among this population are higher than those among Medicare-only enrollees. To understand the reasons dually eligible individuals leave these plans, Mathematica conducted a study supported by Arnold Ventures, which looked specifically at disenrollment patterns in Medicare Advantage plans with a majority of D-SNP members that varied in the range of Medicaid benefits covered. We tested the association of quality and member experience scores, and level of Medicaid integration, with disenrollment rates. We also interviewed key stakeholders to explore the influence of other factors on disenrollment patterns. This report presents key findings from the study and draws implications for federal and state policymakers seeking to increase enrollment and retention in integrated care plans.