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

April 2

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.

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Radar on Medicare Advantage

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.