GAO to CMS: Get More Data on Default Enrollment of Duals

As states consider new standards for Dual Eligible Special Needs Plans (D-SNPs) that will satisfy statutory requirements beginning in calendar year 2021, the enrollment of dual- eligible beneficiaries in Medicare and Medicaid plans that are offered by the same entity has been discussed as a way to promote better coordination of care. A new Government Accountability Office (GAO) report highlights the various approaches some states have taken to encourage the concept of aligned enrollment and recommends that CMS gather more information on one method in particular — the auto- assignment, or default enrollment, of newly eligible duals into an aligned D-SNP.

Along with granting permanent authorization to D-SNPs, the Bipartisan Budget Act of 2018 called for D-SNPs and states to better unify appeals and grievances processes across the Medicare and Medicaid programs and set new minimum standards for D-SNPs integrating Medicaid benefits. According to the March report, “Alignment of Managed Care Plans for Dual-Eligible Beneficiaries,” that legislation also directed GAO to review the integration between D-SNP and state Medicaid programs.

© 2021 MMIT

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues, including drug benefits and specialty pharmacy, for more than a decade. She served as editor of Drug Benefit News (the predecessor to Radar on Drug Benefits) from 2004 to 2005 and again from 2011 to 2016, and now manages Radar on Medicare Advantage. Lauren graduated from Vassar College with a B.A. in English.

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