Dual Eligible Population Enrolled In Medicaid Managed Care Nearly Doubled Since 2011 – OPEN MINDS Releases 2018 Update On Dual Eligible Financing

Gettysburg, PA, July 19, 2018 (GLOBE NEWSWIRE) -- A new report from OPEN MINDS found that 40% of full-benefit dual eligibles were enrolled in Medicaid managed care in 2017; a rapid increase from 2011, when 24% of the population was enrolled in Medicaid managed care. While national trends show a consistent push towards managed care for this population, there is a wide variation in state’s policies for financing models for the dual eligible population. Dual eligibles are enrolled in only fee-for-service (FFS) systems in twelve states; dual eligibles are enrolled in only managed care systems in three states; and dual eligibles have a choice to enroll in one or more financing systems in thirty-six states. This dual eligible financing systems review was released as part of OPEN MINDS’ highly anticipated market intelligence report, Medicare-Medicaid Dual Eligible 2018 Market Update: Enrollment & Coverage.

In March 2017, there were 10.6 million dual eligible individuals (individuals eligible for both Medicaid and Medicare coverage) – an increase of about 1% since 2016 (when there were 10.5 million dual eligible individuals) and an increase of about 28% since 2009 (when there were 8.3 million dual eligible individuals). The absolute number of dual eligible individuals varies by the size of the state population – California has the largest dual eligible population at 1.45 million, and Wyoming has the smallest at 10,473. Nevada had the greatest increase in their dual eligible population between 2015 and 2017, growing at a rate of 27%. Vermont’s dual eligible population decreased at a rate of 2.8% during the same time period.

Equally important for strategy, is that fact that the proportion of the Medicare and Medicaid dual-eligible enrollees varies widely by state. For example, in Maine, dual eligibles represent 33% of the Medicaid population, while they represent only 8% of the Medicaid population in Colorado. The states with the highest percentage of their Medicare population as dual eligibles include: the District of Columbia at 42%, and Connecticut, Maine, and Mississippi at 29%. Utah and Wyoming report the lowest percentage at 11%.

“In our new analysis of the dual eligible market, we found two trends that I think are important to every organizations planning to serve these consumers. The first is the proportion of the Medicaid and Medicare population that is ‘dual eligible’ varies greatly by state, affecting the total market. The other is the sizable increase in managed care enrollment,” said OPEN MINDS Market Intelligence Director, Athena Mandros. “A large portion of Medicaid and Medicare spending is in play with new opportunities for health plans, care coordination organizations, and provider organizations; but the opportunities vary by type and by size depending on the state. Our report gives provider organization executives a guide to navigating these opportunities.”

A free summary of the report can be found at Is The Dual Eligible Market A Priority? Your Opportunity Depends On The State. The report, Medicare-Medicaid Dual Eligible 2018 Market Update: Enrollment & Coverage, is available at no charge to Premium and Elite members of The OPEN MINDS Circle and can be purchased in the OPEN MINDS shop for $495. The report includes:

  1. Historical and current enrollment data – by dual eligible type, and as a percentage of the Medicaid and Medicare population
  2. Explanation of the health benefit financing model in Medicaid and Medicare for dual eligibles
  3. The percent of dual eligibles enrolled in Medicare managed care
  4. A state-by-state look at the Medicaid financing system for dual eligibles in each state
  5. The percent of dual eligibles in Medicaid managed care

Learn more about becoming an OPEN MINDS Circle member online at www.openminds.com/membership.

For additional questions and inquiries, please contact Sarah C. Threnhauser, Executive Vice President, OPEN MINDS at 717-334-1329 or sthrenhauser@openminds.com


OPEN MINDS is a national market intelligence and strategic advisory firm focused on the sectors of the health and human service field serving consumers with chronic conditions and complex support needs. Founded in 1987 and based in Gettysburg, Pennsylvania, the 175+ associates provide market insights and innovative management solutions designed to improve operational and strategic performance. Learn more at www.openminds.com.


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