Federal Look-Alike Plan Termination Policy and Dual-Eligible Enrollment in Integrated Care Programs

Is the federal policy eliminating nonintegrated dual-eligible special needs plan look-alike plans associated with increased enrollment of Medicare-Medicaid dual-eligible beneficiaries into integrated care plans, particularly those with high-level Medicare-Medicaid integration?This repeated cross-sectional study using Medicare data on full-benefit dual-eligible individuals in 2576 US counties between 2017 and 2023 found that the termination of look-alike plans was not associated with any increase in dual-eligible enrollment into plans with high-level integration. The majority of dual-eligible individuals in terminated look-alike plans transitioned into nonintegrated plans.Results of this study suggest that policymakers should consider additional strategies beyond the look-alike termination policy to expand dual-eligible enrollment in highly integrated plans.

Corresponding Author: Jose F. Figueroa, MD, MPH, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115 (jfigueroa@hsph.harvard.edu).

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