MassHealth Demonstration 
to Integrate Care for Dual Eligibles
Implementation Council Meeting
October 25, 2013, 11:00 AM – 1:00 PM
1 Ashburton Place, 21st Floor
Boston, MA

Status Update: Enrollment for October 1 effective date
■	Enrollments by Plan
o	CCA = 1,193
o	FTC = 259
o	Network Health = 331
o	Total = 1,783
■	Enrollment by Rating Category
o	F1 = 4
o	C3 =284
o	C2 = 269
o	C1 = 1,226
o	Total =1,783
Status Update: Enrollment by County
■	Enrollments by County
o	Essex = 67
o	Franklin = 4
o	Hampden = 465
o	Hampshire = 49
o	Middlesex = 84
o	Norfolk = 41
o	Plymouth = 15
o	Suffolk = 512
o	Worcester = 546
o	Total = 1,783
Status Update: Opt-Outs
■	Total number of opt-outs: 4,261
–	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 individuals who received a One Care enrollment package, ~5.2% have chosen to opt out
■	Opt-Outs by County
o	Barnstable = 1 (One Care is not available in Barnstable County)
o	Bristol = 6 (One Care is not available in Bristol County)
o	Essex = 206
o	Franklin = 24
o	Hampden = 1,143
o	Hampshire = 262
o	Middlesex = 48
o	Norfolk = 35
o	Plymouth = 12
o	Suffolk = 1,027
o	Worcester = 1,497
o	Total = 4,261

Status Update: Early Experience
■	Total enrollment as of Oct. 15 was 2,827

■	Plans have begun reaching out to their new members to begin assessment process and connect members with Care Coordinators

■	MassHealth has provided certain data to plans on enrollees’ services and providers to support continuity of care

■	Joint CMS-MassHealth Contract Management Team (CMT) is in frequent communication with plans to address early glitches as they arise

Upcoming Events 
■	Community Information Sessions: Overview presentation from MassHealth and time for Q&A, to help people learn about One Care
o	Session to date include: 
–	Sept. 23:	   Worcester Public Library, 1-3 pm 
–	Oct. 2: 	   Springfield Public Library, 1-3 pm
–	Oct. 11: 	   Boston, Transportation Building, 3-5 pm
–	Oct. 18: 	   Leominster Public Library, 1-3 pm
o	Upcoming sessions:
–	Nov. 22:    Framingham Public Library, 1-3 pm

■	Health Fairs: One Care plan representatives available to talk about their plans, answer questions, help people consider their options
–	Oct. 24:	Worcester, Hilton Garden Inn,    3-5 pm
–	Nov. 4: 	Boston, Transportation Building,  3-5 pm
–	Nov. 6: 	Springfield, Marriott Hotel,        3-5 pm

Auto-Assignment Overview
■	Auto-assignment (passive enrollment) is the term MassHealth is using to describe the process of assigning, notifying, and automatically enrolling someone in a One Care plan.
■	There are three planned rounds of auto-assignment in the first year.
–	Coverage effective dates: 
January 1, 2014; April 1, 2014; July 1, 2014
■	MassHealth will send two notices to individuals who have been auto-assigned:
–	60-day notice – Informs the member of the plan assignment and coverage effective date.
–	30-day notice – Reminder that changes will take effect in 30 days
–	Both notices will tell people how to opt out or change plans
■	Individuals can self-select in to One Care, disenroll, or opt out at any time. Enrollment changes take effect the first day of the next month.
■	Self-selection enrollment continues while auto-assignment is happening. 

Auto-Assignment Population and Process
■	Individuals may be auto-assigned if they meet all of the following:
–	Live in Hampden, Hampshire, Suffolk, or Worcester County (counties with at least two One Care plans)
–	Received an enrollment packet mailing, and did not enroll or opt out
–	Are not enrolled in Medicare Advantage or PACE plan

■	Not everyone who meets these criteria will be auto-assigned.  This is to ensure sufficient capacity within One Care to handle the volume of enrollees.

■	Estimated number of individuals in the first round: 7,000
–	Will include only members who appear in MassHealth data to have less acute needs than others in the eligible population 
(C1 rating category)
–	MassHealth used data on where individuals accessed primary care services to match individuals to a One Care plan

■	Decisions about how many and which individuals will be assigned in the later rounds will reflect program experience and self-selection enrollment patterns.

■	People living in an auto-assignment county can voluntarily enroll in a One Care plan in their county OR opt out. 

■	If the person chooses to opt out, he/she will not be auto-assigned in the future.

Auto-Assignment Schedule

Round	60-day Auto-Assignment Notice Packet	30-day Reminder Notice Packet	Coverage Effective Date	
First	Mailed on 10/28	Mailed on 11/22	January 1, 2014	
Second	Mailed on 1/28/14	Mailed on 2/25/14	April 1, 2014	
Third	Mailed on 4/25/14	5/28/14	July 1, 2014	

Ombudsman Update
■	Through a competitive procurement process, MassHealth has selected Disability Policy Consortium (DPC) for contract negotiations to provide One Care Ombudsman services

■	DPC’s disabilities expertise will be complemented and supported by:
–	Health Care for All (HCFA)
–	Consumer Quality Initiatives (CQI) 

■	Final contract expected to be in place in the coming weeks

■	DPC will give a stakeholder presentation on its plans for the Ombudsman program after the contract has been executed

Visit us at www.mass.gov/masshealth/onecare 
Email us at onecare@state.ma.us