Dual Eligible Opt-Out Percentage High

Enrollment remains low and opt-outs remain high for the state’s duals demonstration project, particularly in duals-rich Los Angeles County.

In addition, a sizable percentage of enrollees have disenrolled from the program, according to the most recent data from the Department of Health Care Services, which oversees the project as part of its Coordinated Care Initiative (CCI).

In the governor’s proposed fiscal year 2015-2016 budget, the CCI still is listed as cost-effective but that’s primarily because the scales are weighted by a managed care organization tax. Without that tax money, the CCI would show a cost, rather than savings. If those numbers don’t improve by January 2016, the CCI would end operations.

So far, the numbers through Jan. 15 paint a bleak picture of Cal MediConnect enrollment, which originally was projected to have a 33% opt-out rate:

• The opt-out rate in November 2014 hit 54% overall. In January 2015 that percentage dipped to 48%;
• In addition to the high percentage of people declining to enroll, there was also a substantial number of “disenrollees” who had been enrolled and chose to leave the program, 15% overall in November and 12% overall in January;
• Los Angeles County, with by far the largest number of dual eligibles in the state, had the highest opt-out and disenrollment percentages of any of the six participating counties with a 61% opt-out rate in November and 15% disenrollment;
• In November only 25% of the dual eligibles in Los Angeles County actually enrolled; and
• When excluding Los Angeles County, the total numbers look better, with 38% opt-outs and 10% disenrollment in January.

The disenrollment numbers are not strictly those who left the program voluntarily; that figure includes those who lost Medi-Cal benefits and were involuntarily dropped from the program.

DHCS officials pointed out that 88% of the people who enroll in Cal MediConnect stay with program and that indicates a good level of satisfaction with the actual care being received through the program.

“This high retention rate shows that the program is working for those who have been enrolled,” said Anthony Cava, an information officer at DHCS, in an email. “This is evidence that we are working to share with our beneficiary and provider communities. We want them to understand that Cal MediConnect is a tremendous opportunity to improve care and care coordination for dual-eligible members in California.”

DHCS officials said they’re trying to solve the Los Angeles County conundrum, but that there’s not one answer or reason for the higher opt-out rate there.

“We are currently still working through the data analysis to better understand the populations that are opting out,” Cava said. That includes defining the higher opt-out rates and poring over the geographic and demographic details for those areas to find commonalities.

“We hope to have some initial data available to share in the next month,” Cava said.

He added the department is being helped by consumer advocates, health plans and providers to figure out reasons for the higher opt-out rates. Together, they hope to”develop a plan for outreach, education and communication to help improve enrollment in the program,” Cava said. 

As for the viability of CCI, Cava said the goal is simply to have the program be cost-effective, the way it was intended to be.

“There is no specific target or level of participation that drives that determination,” Cava said. “The administration is committed to the goals of CCI and is committed to working to improve enrollment in the Cal MediConnect program, which provides a much more coordinated delivery system for the beneficiaries dually eligible for Medicare and Medi-Cal.”