Few dual-eligibles opt for coordinated care
Low-income and disabled Americans who are eligible for both Medicare and Medicaid are opting out at high rates from voluntary state initiatives aimed at better coordinating their coverage and care.
Dual-eligibles often have a difficult time navigating both programs to get the services they need. Even though the 9 million dual-eligibles make up only 13% of the population enrolled in both programs, they account for 40% of all Medicaid spending and 27% of Medicare spending. Experts say the lack of coordination makes their care far more costly.
Under the federal Financial Alignment Initiative, 11 states have launched or are about to launch three-year demonstration programs that pay insurers capitated rates to offer combined Medicare and Medicaid benefits. But the programs are voluntary for beneficiaries, and most are saying no.
In California, for example, only about 40,000 of the estimated 450,000 dual-eligibles had opted into the state’s Cal Medi Connect program as of July 1, and nearly 40,000 had opted out. In Massachusetts, out of 94,000 people who qualify for its One Care program, only 13,000 had signed up and 21,000 had opted out as of May 1. In Ohio, only about 9,000 of about 114,000 qualifying Ohioans have agreed to participate.
If low participation persists, it will be hard to evaluate the state initiatives, preventing them from being extended more broadly, said Mary-Beth Musumeci, associate director of the Kaiser Commission on Medicaid and the Uninsured.
So far, only Massachusetts has studied why so many beneficiaries decline to participate. According to a February focus group, patients feared losing relationships with trusted healthcare providers and worried they would face new restrictions on services. “It makes sense that continued access to one’s provider is a primary concern for beneficiaries,” said Fay Gordon, a staff attorney at National Senior Citizens Law Center. In California, a state judge on Aug. 1 will consider whether to halt the state’s dual-eligible demonstration. The Los Angeles County Medical Association and several independent-living centers claim the program failed to provide enrollment forms written at or below a sixth-grade reading level. The lawsuit alleges that beneficiaries may not realize they could be severing ties with their current providers when they join the program.
Lisa Rubino, senior vice president of dual-eligible strategy at Molina Healthcare, said the state got extensive feedback from providers and patient advocates before issuing enrollment notices.
The state got extensive feedback from providers and patient advocates before issuing enrollment notices. LISA RUBINO SENIOR VICE PRESIDENT OF DUAL-ELIGIBLE STRATEGY MOLINA HEALTHCARE