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Membership Modeling Membership Timeline Flow Charts Enrollment Enrollment – August 1 through September 30 Adjustments – CRS, SMI Dual Alignment Conversion.

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Presentation on theme: "Membership Modeling Membership Timeline Flow Charts Enrollment Enrollment – August 1 through September 30 Adjustments – CRS, SMI Dual Alignment Conversion."— Presentation transcript:

1 Membership Modeling Membership Timeline Flow Charts Enrollment Enrollment – August 1 through September 30 Adjustments – CRS, SMI Dual Alignment Conversion Conversion Examples Charts/Graphs Relinquishing Plan < 45% - GSAs 2 and 4 Two new plans – GSA 6 Relinquishing Plan > 55% – GSA Relinquishing Plan > 45% and < 55% – Santa Cruz and GSA 14 Pima County

2 Membership Modeling Timeline May 1 Test for Small Contractors for Conversion (exception: GSA 12 due to capped contract) August 1 Freeze Auto Assignment and Choice for Relinquishing Contractors (exceptions: GSA 6 where both incumbents are relinquishing, GSA 12 due to capped contract) September 1 Test for Small Contractors for Enhanced Auto Assignment October 1 Adjustments, Conversion, Enhanced Auto Assignment

3 Enrollee NB, FC, Reenrollment, etc.? Yes Follows Plan No August 1 to September 30? No Choice? Yes Follows Choice No Auto Assignment Yes Proceed to August 1 to September 30 Enrollment Chart A Enrollment Flow Chart

4 A August 1 to September 30 Enrollment GSA ? GSAs 2, 4, 8, 10, 14 and Santa Cruz Freeze Enrollment and Auto Assignment Choice? Yes Follows Choice No Auto Assignment GSAs 6 and 12 Choice? Yes Follows Choice No Auto Assignment Enrollment August 1 to September 30

5 Membership CRS ? Yes Move to CRS No SMI? No Duals ? No Proceed to Conversion C Yes Proceed to Dual Alignment B Yes GSA? All Other GSAs Proceed to Dual Alignment B GSA 12 Move to Mercy Maricopa Integrated Care October 1 Adjustments

6 B Dual Alignment Aligned with Medicare Plan? No Aligned Plan Continuing? Yes Align with Plan No Proceed to Conversion C Yes Plan Continuing? Yes Remain with Plan No Proceed to Conversion C Dual Alignment

7 C Conversion Plan Continuing or Capped? No Identify threshold and small plans Move members to small plans based on size and threshold Conversion complete? No All plans at Threshold? Yes Auto Assign No Yes Ready for CYE14 Enrollment Yes Remain with Plan Conversion

8 Conversion Example Relinquishing Plan < 45% GSAs 2 and 4 RelinquishingIncumbentNewGSA Total Membership at 9/30 22,00052,00074,000 Adjustment – CRS -300-900-1,200 Adjusted Total 21,70051,10072,800 - Dual Alignment -700-1,300-2,000 + Dual Alignment 2,000 Conversion -21,00021,0000 Membership 10/1 051,80021,00072,800

9 Conversion Example Relinquishing Plan < 45% GSAs 2 and 4

10 Conversion Example Two New Plans GSA 6 Relinquishing A Relinquishing B New Plan ANew Plan BGSA Total Membership 9/3016,00015,00031,000 Adjustment – CRS-200 -400 Adjusted Total15,80014,80030,600 - Dual Alignment-500-400-900 + Dual Alignment900 Conversion Group-15,300-14,400-29,700 Conversion to Small (45%)6,0756,97513,050 Auto Assignment (50/50 Modeled)8,325 16,650 Membership 10/10015,300 30,600

11 Conversion Example Two New Plans GSA 6

12 Conversion Example Relinquishing Plan > 55% GSA 8 IncumbentRelinquishingNewGSA Total Membership 9/30 18,00028,00046,000 Adjustment – CRS -250-500-750 Adjusted Total 17,75027,50045,250 - Dual Alignment -100-50-150 +Dual Alignment 25125150 Conversion Group -27,450 Conversion to Small (45%) 3,02520,57523,600 Auto Assignment (50/50 Modeled) 1,925 3,850 Membership 10/1 22,625 45,250

13 Conversion Example Relinquishing Plan > 55% GSA 8

14 Example of One New Plan Relinquishing Plan > 45% and < 55% Santa Cruz and GSA 14 RelinquishingIncumbentNewGSA Total Membership 9/30 15,50014,50030,000 Adjustment – CRS -225-250-475 Adjusted Total 15,27514,25029,525 - Dual Alignment -525-100-625 + Dual Alignment 25600625 Conversion Group -14,750 Conversion to Small (45%) 12,900 Auto Assignment (50/50 Modeled) 925 1,850 Membership 10/1 015,10014,42529,525

15 Example of One New Plan Relinquishing Plan > 45% and < 55% Santa Cruz and GSA 14

16 Conversion GSA 10 Pima County Relinquishing Incumbent A Incumbent B Incumbent C Incumbent D New E GSA Total Membership 9/3017,000 60,00035,00024,00027,000163,000 Adjustment – CRS-300-1,200 -800-400-500-3,200 Adjusted Total16,70058,80034,20023,60026,500159,800 - Dual Alignment-250-75-455-415-355-1,550 + Dual Alignment1,3653560901,550 Conversion Group-16,45016,4500 Membership 10/1060,09033,78023,24526,23516,450159,800

17 Conversion Example GSA 10 Pima County

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