State Guide to Identifying Aligned Enrollees: How to Find Medicare Plan Enrollment for Dually Eligible Individuals in Medicaid Managed Care Plans

Integrated Care Resource Center
July 2020

States can advance integrated care for dually eligible individuals by promoting aligned enrollment in Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) and Medicaid managed care plans owned by the same parent company (“affiliated” plans). Dually eligible individuals who receive Medicare and Medicaid coverage from affiliated plans can benefit from improved integration of benefits and care coordination.

In order to promote aligned enrollment and facilitate coordination for unaligned enrollees, states need to know where dually eligible individuals are enrolled for their Medicare and Medicaid coverage. States that identify aligned (and unaligned) dually eligible enrollees can share that information with Medicare and/or Medicaid health plans to promote care coordination for members of these plans. In addition, states with integrated care programs are asked to report information about aligned enrollment to the Centers for Medicare & Medicaid Services (CMS) Medicare-Medicaid Coordination Office (MMCO) on an annual basis, and may wish to share this data with state legislators or other stakeholders as well.

This technical assistance tool explains how states can identify aligned and unaligned enrollees within their dually eligible populations through two methods: (1) accessing CMS data on Medicare plan enrollment and matching it with Medicaid plan enrollment data; or (2) collecting aligned enrollment data directly from D-SNPs.