Few dual-el­i­gi­bles opt for co­or­di­nated care

Modern Healthcare - - NEWS - By Vir­gil Dick­son

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

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.