In my previous post [1], I was too quick to arrive at a conclusion saying that Kaiser's membership dropped - its flagship contract dropped; that's a fact. To be clear, Kaiser's total membership grew. So, I was investigating what was going on. It turned out Kaiser now has a new D-SNP contract, H8794. After looking at all contract numbers side by side, the most logical conclusion I can draw is Kaiser moved its members to a new D-SNP plan. The question now is, would this re-routing of members have happened with/without the drop of the Star Rating... [1] https://lnkd.in/errgVqh5
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I suspect, only, that those eligible for the new dual eligible KP plan previously had to have separate Medicaid and MA plans. If that's right, it's unlikely the STAR ratings had anything to do with it, and it's more likely that KP found out that the D-SNP plans would pay KP better
It's a regulatory change and a trend you will see continue since SNP membership need to have it's own H contract. To writing MOCs we will go..
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9moUnfortunately, I believe the answer to be little boring. California began requiring all of insurers with 2024 MA contracts to separate the D-SNPs into a separate H Contract. Starting in 2024, states like CA get to choose whether they want to pursue a D-SNP only MA contracting model. https://www.dhcs.ca.gov/provgovpart/Documents/DHCS-D-SNP-only-H-Contract-Notice.pdf