Membership Modeling Membership Timeline Flow Charts Enrollment August

Membership Modeling § Membership Timeline § Flow Charts • 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

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

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

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

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

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

C Conversion Plan Continuing or Capped? No Yes Identify threshold and small plans Remain with Plan Move members to small plans based on size and threshold Conversion complete? No Yes All plans at Threshold? Ready for CYE 14 Enrollment No Yes Auto Assign

Conversion Example Relinquishing Plan < 45% GSAs 2 and 4 Relinquishing Membership at 9/30 Adjustment – CRS Adjusted Total - Dual Alignment Incumbent Membership 10/1 GSA Total 22, 000 52, 000 74, 000 -300 -900 -1, 200 21, 700 51, 100 72, 800 -700 -1, 300 -2, 000 + Dual Alignment Conversion New -21, 000 0 51, 800 21, 000 72, 800

Thousands Conversion Example Relinquishing Plan < 45% GSAs 2 and 4 60 Conversion Group 50 40 Dual Alignment (in) 30 20 Dual Alignment (out) 10 0 Relinquishing Incumbent New Adjustment - CRS -10 -20 -30 Membership 9/30

Conversion Example Two New Plans GSA 6 Relinquishing A B Membership 9/30 Adjustment – CRS Adjusted Total - Dual Alignment New Plan B GSA Total 16, 000 15, 000 31, 000 -200 -400 15, 800 14, 800 30, 600 -500 -400 -900 + Dual Alignment Conversion Group New Plan A 900 -15, 300 900 -14, 400 -29, 700 Conversion to Small (45%) 6, 075 6, 975 13, 050 Auto Assignment (50/50 Modeled) Membership 10/1 8, 325 15, 300 16, 650 30, 600 0 0

Thousands Conversion Example Two New Plans GSA 6 20 Auto Assignment (50/50 Modeled) Conversion to Small (45%) 10 Conversion Group 0 -10 Dual Alignment (in) Relinquishing New Plan A A B New Plan B Dual Alignment (out) Adjustment - CRS Membership 9/30 -20

Conversion Example Relinquishing Plan > 55% GSA 8 Incumbent Relinquishing New GSA Total 18, 000 28, 000 46, 000 -250 -500 -750 17, 750 27, 500 45, 250 - Dual Alignment -100 -50 -150 +Dual Alignment 25 Membership 9/30 Adjustment – CRS Adjusted Total 125 -27, 450 Conversion Group 150 -27, 450 Conversion to Small (45%) 3, 025 20, 575 23, 600 Auto Assignment (50/50 Modeled) 1, 925 3, 850 22, 625 45, 250 Membership 10/1

Thousands Conversion Example Relinquishing Plan > 55% GSA 8 30 Auto Assignment (50/50 Modeled) 20 Conversion to Small (45%) 10 Conversion Group 0 Dual Alignment (in) -10 Relinquishing Small Incumbent New Dual Alignment (out) Adjustment - CRS -20 Membership 9/30 -30

Example of One New Plan Relinquishing Plan > 45% and < 55% Santa Cruz and GSA 14 Relinquishing Membership 9/30 Adjustment – CRS Adjusted Total - Dual Alignment Incumbent Membership 10/1 GSA Total 15, 500 14, 500 30, 000 -225 -250 -475 15, 275 14, 250 29, 525 -100 -625 25 + Dual Alignment Conversion Group Conversion to Small (45%) Auto Assignment (50/50 Modeled) New 600 -14, 750 0 625 -14, 750 12, 900 925 1, 850 15, 100 14, 425 29, 525

Thousands Example of One New Plan Relinquishing Plan > 45% and < 55% Santa Cruz and GSA 14 20 Auto Assignment 10 Conversion to Small (45%) Conversion Group 0 -10 Relinquishing Incumbent New Dual Alignment (in) Dual Alignment (out) Adjustment - CRS -20 Membership 9/30

Conversion GSA 10 Pima County Incumbent A B C D Relinquishing Membership 9/30 Adjustment – CRS Adjusted Total - Dual Alignment Membership 10/1 GSA Total 17, 000 60, 000 35, 000 24, 000 27, 000 163, 000 -300 -1, 200 -800 -400 -500 -3, 200 16, 700 58, 800 34, 200 23, 600 26, 500 159, 800 -250 -75 -455 -415 -355 -1, 550 1, 365 35 60 90 1, 550 + Dual Alignment Conversion Group New E -16, 450 0 60, 090 33, 780 23, 245 26, 235 16, 450 0 16, 450 159, 800

Thousands Conversion Example GSA 10 Pima County 70 60 Conversion 50 40 Dual Alignment (in) 30 20 Dual Alignment (out) 10 0 -10 Relinquishing Incumbent A Incumbent B Incumbent C Incumbent D New E Adjustment - CRS -20 -30 Membership 9/30