Managed Care Enrollment by Program and Population (Duals)

2024  Enrollment Data by Program and Population (Dually Eligible Individuals)

The Enrollment Data by Program and Population (Dually Eligible Individuals) table (Table 3 in the Enrollment Report) shows each state and territory’s number of dually eligible individuals in the total population, and the number of dually eligible individuals enrolled each managed care program type - Comprehensive Managed Care Organization (MCO), Primary Care Case Manager (PCCM), Primary Care Case Management Entity (PCCM Entity), Managed Long-Term Services and Supports (MLTSS), Behavioral Health Organization (BHO), Dental, Non-Emergency Medical Transportation (NEMT), Program of All-Inclusive Care for the Elderly (PACE), and Other.
 
1.	The “Total Dually Eligible Individuals” column represents an unduplicated count of all enrollees in FFS and any type of managed care, including enrollees receiving full Medicaid benefits or Medicaid cost sharing.
2.	States are asked to abstain from reporting Financial Alignment Initiatives (FAI) in their enrollment data submissions. However, in 2024, New York reported a FAI program called Fully Integrated Duals Advantage for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD). 
3.	Tennessee’s 2024 data submission indicated they were unable to provide an unduplicated count of enrollees in comprehensive MCO programs. Therefore, Table 3 does not include Tennessee’s dually eligible enrollees enrolled in managed care by program type.
4.	Washington reported a number for total dually eligible individuals in “BHO (PIHP and/or PAHP)” that was greater than “Total Dually Eligible Individuals” but did not provide an explanation for why this number was greater.

Notes: “--” indicates the state or territory does not operate a specific program type or does not have a managed care program; this value could not be collected for FFS states and territories. “0” indicates that a state operated a program of this type in 2024 but reported 0 dually eligible individuals enrolled as of July 1, 2024. “***” indicates the state operated a program of this type in 2024 but was unable to provide an unduplicated count of enrollees for at least one of their managed care programs.

Because dually eligible individuals may be concurrently enrolled in more than one type of managed care program (e.g., a comprehensive MCO and a BHO), users should not sum enrollment across all program types, since the total would count individuals more than once and, in some states, exceed the actual number of Medicaid enrollees.

2023  Enrollment Data by Program and Population (Dually Eligible Individuals)

The Enrollment Data by Program and Population (Dually Eligible Individuals) table (Table 3 in the Enrollment Report) displays each state and territory’s number of dually eligible individuals in the total population, and the number of dually eligible individuals enrolled each managed care program type - Comprehensive Managed Care Organization (MCO), Primary Care Case Manager (PCCM), Primary Care Case Management Entity (PCCM Entity), Managed Long-Term Services and Supports (MLTSS), Behavioral Health Organization (BHO), Dental, Non-Emergency Medical Transportation (NEMT), Program of All-Inclusive Care for the Elderly (PACE), and Other.

1.	The “Total Dually Eligible Individuals” column represents an unduplicated count of all enrollees in FFS and any type of managed care, including enrollees receiving full Medicaid benefits or Medicaid cost sharing.
2.	Minnesota reported a number for dually eligible individuals in “Comprehensive MCO (with or without MLTSS)” that was greater than “Total Dually Eligible Individuals” but did not provide an explanation for why this number was greater.
3.	In 2023, New York reported a program called Fully Integrated Duals Advantage for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD). This additional program combined with an increase in enrollment due to the Public Health Emergency, resulted in an increase from 2022 for total dually eligible individuals in “Comprehensive Managed Care (with or without MLTSS)”.
4.	Tennessee’s 2023 data submission indicated they were unable to provide an unduplicated count of enrollees in comprehensive MCO programs. Therefore, Table 3 does not include Tennessee’s dually eligible enrollees enrolled in managed care by program type. 
5.	Washington reported a number for total dually eligible individuals in “BHO (PIHP and/or PAHP)” that was greater than “Total Dually Eligible Individuals” but did not provide an explanation for why this number was greater.

Notes: “--” indicates the state or territory does not operate a specific program type or does not have a managed care program; this value could not be collected for FFS states and territories. “0” indicates that a state operated a program of this type in 2023 but reported 0 dually eligible individuals enrolled as of July 1, 2023. “***” indicates the state operated a program of this type in 2023 but was unable to provide an unduplicated count of enrollees for at least one of their managed care programs.

Because dually eligible individuals may be concurrently enrolled in more than one type of managed care program (e.g., a comprehensive MCO and a BHO), users should not sum enrollment across all program types, since the total would count individuals more than once and, in some states, exceed the actual number of Medicaid enrollees.