Federal Look-Alike Plan Termination Policy and Dual-Eligible Enrollment in Integrated Care Programs

Area of Science:

• Health Services Research
• Public Health Policy
• Medicare and Medicaid Studies

Background:

• The Centers for Medicare & Medicaid Services terminated dual-eligible special needs plan look-alikes in 2023.
• These plans had over 80% dual-eligible individuals but lacked Medicaid integration.
• Understanding the impact on enrollment in integrated care plans is critical.

Purpose of the Study:

• To describe dual-eligible enrollment transitions following the termination of look-alike plans.
• To evaluate if the policy increased enrollment in highly integrated plans.

Main Methods:

• A repeated cross-sectional study analyzed US Medicare administrative data from 2017 to 2023.
• Beneficiary-level analysis examined 2023 enrollment patterns for individuals in terminated plans.
• A difference-in-differences design compared enrollment changes before and after the policy.

Main Results:

• Only 5.4% of individuals in terminated look-alike plans transitioned to highly integrated plans; 55.6% moved to nonintegrated plans.
• The termination policy was not associated with a significant increase in enrollment into highly integrated plans.
• A modest increase was observed in plans with some integration and conventional Medicare Advantage plans.

Conclusions:

• The termination of look-alike plans was insufficient to significantly shift dual-eligible individuals toward highly integrated care.
• Complementary strategies are necessary to encourage enrollment in highly integrated care models.
• Further research is needed to optimize integrated care pathways for dual-eligible beneficiaries.