DOH Explains Phased "Unwind" of Dual Eligibles from Mainstream Managed Care

At a meeting of managed care plans on Feb. 8, 2024, the Department of Health (DOH) described the phased transition under way of Medicare-Medicaid dual eligibles out of mainstream Medicaid managed care plans. During the COVID-19 Public Health Emergency, Medicaid beneficiaries who turned 65 and became eligible for Medicare were allowed to remain in their existing mainstream Medicaid managed care plan, due to federal continuous coverage requirements. The slide presentation is available here.

With the initiation of the COVID-19 unwind process in July 2023, DOH began a phased process for transitioning approximately 100,000 dual eligibles enrolled in mainstream Medicaid managed care plans who are not also enrolled in the plan’s aligned Medicare Dual Eligible Special Needs Plan (D-SNP). The timing and process of the transition for each beneficiary will vary based on several factors, including whether their coverage is through the NY State of Health insurance marketplace or the Welfare Management System and whether they are receiving community-based long-term services and supports (CBLTSS).

Duals Not Receiving CBLTSS

Some dual eligibles are enrolled in both a mainstream Medicaid managed care plan and that plan’s associated D-SNP – a program known as the Integrated Benefit for Dual Eligible Enrollee (IBD) Program. These beneficiaries are referred to as “IB-Duals.” IB-Duals who are not receiving CBLTSS may remain in their plan and will not be transitioned. Dual eligibles who are enrolled in a mainstream managed care plan, but are not enrolled in that plan’s IB-Duals Program, and are not receiving CBLTSS will be transitioned to Medicaid fee-for-service (FFS) at their renewal date.

Duals Receiving CBLTSS

Dual eligibles who are receiving CBLTSS and are enrolled in a mainstream managed care plan (including those who are IB-Duals) will be transitioned to Managed Long Term Care (MLTC) plans or to Medicaid FFS (if they have a status that precludes enrollment in an MLTC). They will remain in their mainstream plan until they are transitioned to MLTC. If they are inadvertently disenrolled to FFS, DOH will work with the plans to re-enroll them. The logistics for transitioning these dual eligibles will be discussed at a later date.

Transition Timing

Generally, the timing of these transitions will be based on the beneficiary’s renewal date; however, those with Supplemental Security Income (SSI)-related eligibility are already being transitioned. This spring, mainstream plans will be receiving a file of members who are not IB-Duals and have already renewed their eligibility in 2023 to determine their CBLTSS status. This will occur again later in 2024.

Contact: Karen Lipson, klipson@leadingageny.org