One Care: Masshealth Plus Medicare s1
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Slide 1 One Care: MassHealth plus Medicare
MassHealth Demonstration to Integrate Care for Dual Eligibles
July 2015 Enrollment Report
Slide 2 Monthly Enrollment Report
■ MassHealth issues monthly reports on One Care enrollment activity
■ Reports are issued mid-month
■ Reports are intended to provide general information to stakeholders
Slide 3 One Care Rating Category Definitions
■ F1 – Facility-based Care. Individuals identified as having a long-term facility stay of more than 90 days ■ C3 – Community Tier 3 – High Community Need. Individuals who have a daily skilled need; two or more Activities of Daily Living (ADL) limitations AND three days of skilled nursing need; and individuals with 4 or more ADL limitations – In CY2014, C3 split into two subsets: • C3B: for C3 individuals with certain diagnoses (e.g., quadriplegia, ALS, Muscular Dystrophy and Respirator dependence) leading to costs considerably above the average for current C3 • C3A: for remaining C3 individuals ■ C2 – Community Tier 2 – Community High Behavioral Health. Individuals who have a chronic and ongoing Behavioral Health diagnosis that indicates a high level of service need – In CY2014, C2 split into two subsets • C2B: for C2 individuals with co-occurring diagnoses of substance abuse and serious mental illness • C2A: for remaining C2 individuals ■ C1 – Community Tier 1 Community Other. Individuals in the community who do not meet F1, C2 or C3 criteria Slide 4 Total Enrollment
■ Effective July 1, 2015, total number of enrollees: 17,671
The following information was displayed in a table:
Total Enrollment by Plan Commonwealth Care Alliance (CCA) 10,536 Fallon Total Care (FTC) 5,373 Tufts Health Plan-Network Health 1,762 Total 17,671 End of table.
The following information was displayed in a table:
Total Enrollment by Rating Category F1 33 C3B 153 C3A 4,622 C2B 928 C2A 3,639 C1 8,293 Unavailable* 3 Total 17,671 End of table.
*Rating categories for five enrollments were unavailable at the time of this report
Slide 5 Enrollment Penetration by County
The following information was displayed in a table:
County Enrolled Eligible % Eligible Enrolled Essex 1,025 15,047 6.8% Franklin 86 2,144 4.0% Hampden* 4,712 15,481 30.4% Hampshire* 508 2,667 19.0% Middlesex 1,387 18,237 7.6% Norfolk 584 7,552 7.7% Plymouth 448 7,213 6.2% Suffolk* 3,960 15,597 25.4% Worcester* 4,961 15,679 31.6% Total 17,671 99,617 17.7% End of table. This information was a footnote: *Auto assignment county
Slide 6 Enrollment Over Time
The following information was displayed in a line graph format:
Monthly One Care Enrollments New One Care Enrollments 2013 Oct 1,776 Nov 2,188 Dec 1,166 2014 Jan 5,010* Feb 540 Mar 534 Apr 3,862* May 946 June 711 July 5,864* Aug 265 Sept 267 Oct 258 Nov 1,053* Dec 214 2015 Jan 244 Feb 313 Mar 231 Apr 217 May 181 June 225 July 195
Total Enrolled 2013 Oct 1,776 Nov 3,788 Dec 4,714 2014 Jan 9,484* Feb 9,520 Mar 9,700 Apr 13,167* May 13,253 June 13,401 July 18,815* Aug 18,057 Sept 17,730 Oct 17,466 Nov 18,139* Dec 17,920 2015 Jan 17,839 Feb 17,759 Mar 17,792 Apr 17,700 May 17,675 June 17,708 July 17,671 End of table.
This information was a footnote:
*Auto-assignment effective dates (1/1/2014, 4/1/ 2014, 7/1/2014, 11/1/14). Round 4 consisted only of auto-assignments to Tufts Health Plan-Network Health. Note: Data in the graph reflect current month information about enrollments. Monthly data may vary slightly from the previous reports due to enrollment status changes that have occurred since previous reports were issued.
Slide 7 Opt-Outs
■ Total number of opt-outs as of July 1: 27,684 – Will be excluded from any future auto-enrollment – If eligible, can choose to enroll by self-selection at any time
■ Total opt-out number includes individuals who may be ineligible
■ Of the 99,617 individuals who are eligible for One Care, ~28.0% have chosen to opt out
The following information was displayed in a table.
Total Opt-Outs by County Essex 2,446 Franklin 400 Hampden 6,300 Hampshire 1,475 Middlesex 3,554 Norfolk 1,516 Plymouth 1,133 Suffolk 3,854 Worcester 6,885 Non-Demo Counties 121 Total 27,684 End of table.
Slide 8
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