Dually eligible beneficiaries began enrolling in integrated Medicare-Medicaid plans (MMPs) under the Financial Alignment Initiative (FAI) in calendar year 2013. Under the FAI, the Centers for Medicare & Medicaid Services (CMS) and 10 participating states contracted with MMPs under capitated arrangements to coordinate Medicare and Medicaid benefits. Beneficiary participation has been lower than anticipated. Only about 29 percent of eligible individuals enrolled in MMPs in 2017.

To better understand the low enrollment, MACPAC contracted with Mathematica Policy Research to examine program elements, state policies, and MMP characteristics, and strategies to identify factors associated with enrollment. The analysis included interviews with state Medicaid officials in the 10 states and representatives from 15 MMPs. The analysis identified three primary factors leading to higher enrollment, including: (1) using passive enrollment; aligning key features of managed long-term services and supports programs with the FAI demonstrations; and (3) allowing care coordinators to contact beneficiaries prior to passive enrollment and encouraging coordinators to set up face-to-face visits with new members. States and health plans that adopted these approaches had higher participation rates or absolute numbers of dually eligible beneficiaries enrolled in their demonstrations.