One Care: Masshealth Plus Medicare
Slide 1
One Care: MassHealth plus Medicare
MassHealth Demonstration to Integrate Care for Dual Eligibles
September 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 September 1, 2015, total number of enrollees: 17,179
The following information was displayed in a table:
Total Enrollment by Plan
Commonwealth Care Alliance (CCA)¹ 10,664
Fallon Total Care (FTC) 4,684
Tufts Health Plan² 1,831
Total 17,179
End of table.
This information was included as footnotes to the table:
1 As of August 7, 2015, CCA is temporarily not accepting new One Care enrollments. Members previously enrolled with CCA for One Care may re-enroll.
2 As of August 24, 2015, Tufts Health Plan will accept up to 500 One Care enrollments in Worcester County through December 31, 2015. Tufts is accepting One Care enrollments without limit in Suffolk County.
The following information was displayed in a table:
Total Enrollment by Rating Category
F1 40
C3B 149
C3A 4,793
C2B 927
C2A 3,552
C1 7,717
Unavailable** 1
Total 17,179
End of table.
**The rating category for one enrollment was 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 1,015 15,164 6.7%
Franklin 85 2,185 3.9%
Hampden* 4,557 15,621 29.2%
Hampshire* 486 2,687 18.1%
Middlesex 1,402 18,407 7.6%
Norfolk 576 7,596 7.6%
Plymouth 447 7,295 6.1%
Suffolk* 3,878 15,722 24.7%
Worcester* 4,733 15,846 29.9%
Total 17,179 100,523 17.1%
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 2,187
Dec 1,166
2014
Jan 5,010*
Feb 541
Mar 534
Apr 3,862*
May 946
June 710
July 5,864*
Aug 264
Sept 267
Oct 258
Nov 1,053*
Dec 214
2015
Jan 244
Feb 308
Mar 231
Apr 216
May 181
June 225
July 192
Aug 177
Sept 83
Total Enrolled
2013
Oct 1,776
Nov 3,787
Dec 4,713
2014
Jan 9,483*
Feb 9,520
Mar 9,702
Apr 13,167*
May 13,252
June 13,400
July 18,815*
Aug 18,056
Sept 17,728
Oct 17,465
Nov 18,137*
Dec 17,918
2015
Jan 17,848
Feb 17,759
Mar 17,792
Apr 17,699
May 17,676
June 17,712
July 17,670
Aug 17,519
Sept 17,179
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.
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 September 1: 28,189
– 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 100,523 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 2,464
Franklin 401
Hampden 6,451
Hampshire 1,495
Middlesex 3,566
Norfolk 1,527
Plymouth 1,147
Suffolk 3,927
Worcester 7,076
Non-Demo Counties 135
Total 28,189
End of table.
Slide 8
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