Dual Opt-Out Numbers Are Slightly Better This Month

The Cal MediConnect program got a little good news in the latest enrollment numbers: The percentage of e dual eligible opt-outs dropped slightly from 47% in October to 45% in November.

Excluding Los Angeles County, which has the state’s largest number of residents dually eligible for Medicaid and Medicare, the percentages looked even better, with a 30% opt-out rate this month, compared to 37% a month ago.

The program also got a bit of bad news, as unenrollment numbers rose slightly. Those people who were enrolled in Cal MediConnect and then dropped out of it went from 9% in October to 10% in November.  

Opt-outs have been a struggle for Cal MediConnect, which is part of the state’s Coordinated Care Initiative. The state hopes to improve services and coordinate the care for those Californians dually eligible for Medicare and Medi-Cal benefits, and save money in the process. But it has been tough sledding to sign up duals in the seven-county demonstration project.

Health officials expected a maximum of about a third of all duals to reject the plan, but opt-out and unenrollment numbers have climbed far above that. It has been particularly problematic in Los Angeles and Orange counties.

Last month and this month, for instance, Orange County had a 69% opt-out rate. Los Angeles County, with about two-fifths of the duals in the entire demonstration project, had a 54% opt-out rate in October and that actually rose to 55% this month.

In contrast, San Mateo County had only 13% of its potential enrollees opt out, with 5% unenrolling. The other four demonstration counties’ opt-outs range from 34% to 40%.

State health officials and UC researchers have been working to figure out why the opt-out rate is so high in two of the seven demonstration counties, and the state has been conducting numerous outreach efforts to help people understand the potential benefits of the Cal MediConnect program.

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Capitol Desk Medi-Cal Medicare