Newbies Slow Dual Eligible Expansion in Key States

After last week’s AHIP conference on Medicare and Medicaid and MANY coffees and cocktails later, a picture emerged that the only thing slowing the movement of dual eligibles into health plans isn’t nervous advocacy groups or overstretched regulators — it’s newbies to the game of caring for the nation’s most vulnerable patients.

Dual-eligible expansion has slowed in key states due to the influx of a number of inexperienced plans in states like Florida and New York — Florida in particular, where provider-sponsored plans and other late-comers are popping up like mushrooms in response to the state’s long-term care integration RFP.  Ohio has selected its plans in a tortured process, but many are newcomers to duals and many influential providers are in disarray, slowing momentum. By contrast, California is moving apace — in counties with experienced plans like Orange and Los Angeles, while delaying implementation in counties covered by plans with little or no track record.

Some interesting challenges lay ahead for Melanie Bella’s Office of Federal/State Integration at CMS, which has handled the surge admirably but now needs to balance quality priorities against Medicaid agencies that want fewer strings attached despite the flood of newbies. At this stage CMS’s pipeline and market intel suggests the following states to watch:

To address the “newbie” phenomenon, I suspect in many of these states some very strange bedfellows will emerge, like Blue Cross/Blue Shield plans partnering with large provider systems or traditional Medicaid-focused plans.  Stay tuned — it ain’t easy getting a $200 billion market off the ground among companies with precious little track record in serving those who need their services the most.  The launch of Part D will seem like a milk run once this transition is complete.