Los Angeles Provider Groups Upset Over Opt-Out Forms for Duals Project

Health care provider groups in Los Angeles County expressed concern about whether dual-eligibles will get a full chance to opt out of the state’s demonstration project slated to launch in seven California counties April 1.

The pilot project combines the disparate services and financing of Medicare and Medi-Cal for people who are dually eligible for both. Dual-eligibles would theoretically get better care and more services in an integrated approach and the state would save money by combining the finances from the two programs.

Temporarily excluding Orange County, which had initially been part of the duals project, the state plans to target roughly 399,000 dual-eligible Californians in seven other counties to try to move them into a managed care program. The largest population of duals is in Los Angeles County, where initial enrollment in the pilot project has been capped at 200,000 people.

The Los Angeles County Medical Association and the Los Angeles County Podiatric Medical Society expressed concern about the ability of duals to opt out of the program. In a letter to state health officials, providers wrote:

“We believe that the pilot will compromise and jeopardize the health of some of Los Angeles County’s most vulnerable patients.”

If beneficiaries do nothing, they will be automatically enrolled in managed care plans — a process known as passive enrollment. However, all beneficiaries have the right to opt out of the program.

The groups objected to the size and scope of the project, but also had one specific worry — that the state’s opt-out form will not be available to duals.

“You stated repeatedly that easy-to-understand and navigate opt-out forms would be available and provided (in different languages) for the patients,” the letter said. The opt-out form has been replaced by a choice form accompanying 60-day notices of the transition. The two provider groups were upset at that change.

“Not only is [the choice form] confusing but the ‘opt-out option’ is not clearly listed on the form,” the provider groups said. “In addition, the choice form pertains only to Medi-Cal, not Medicare. Not only is this unacceptable; it is disingenuous.”

At a legislative oversight hearing last week, Toby Douglas, director of the Department of Health Care Services, addressed some of the concerns about outreach.

“We are making sure our beneficiaries know about our process,” Douglas said. A call center specific to the duals program is about to be launched, and beneficiaries get notices at 90 days, 60 days and again at 30 days. That should give them the time they need to decide whether or not to decide about their participation in the program, he said.

Contact from the state is person-specific, Douglas said, because of the phased-in approach and different start times of the transition for different counties.

“That has to do with lessons learned [from previous managed care transitions] and with stakeholder involvement,” Douglas said.

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Capitol Desk Medi-Cal Medicare