One-Quarter of Possible Participants Have Opted Out of the Duals Project

About 50,000 Californians so far have enrolled in Cal MediConnect, according to figures released Monday by the Department of Health Care Services, which oversees the program.

However, about twice that number — a little more than 100,000 duals — have chosen to opt out of the program.

The duals demonstration project known as Cal MediConnect is targeting roughly 430,000 Californians in seven counties who are dually eligible for Medi-Cal and Medicare. So far 107,685 of them have asked to be excluded from the program. That’s about one-fourth of possible participants.

In contrast, 51,527 enrolled in the program as of Nov. 1.

The numbers can be a little confusing because the opt-out numbers seem so much greater than the opt-ins.

That’s because the ones who opt out can make that decision at any time in the process, and opt-ins generally add up as they’re automatically enrolled into the program. Since it’s still early in the enrollment process, a lot of the people who eventually will be enrolled in Cal MediConnect have not yet been counted as enrollees. In the next few months, the number of enrollees is expected to climb significantly.

“This is due to the way the opt-out rate is determined,” said Tony Cava, a public information officer at DHCS, in an e-mail. “We include in the calculation all individuals who have received 90-day notices, since those are the individuals who could have made a decision to opt out. This leads to a mismatching of the total number of people who could actually be enrolled at the time and the total number of people who could have made a choice to opt out.”

Overall, there has been a 33% opt-out rate from Cal MediConnect, state documents say. That seven-county rate has been skewed by higher-than-expected opt-out numbers in Los Angeles County. About 40% of those in the Los Angeles dual-eligible pool have opted out of the program. With a target population of 200,000 duals, Los Angeles is by far the biggest fish in the duals pool.

The important point, Cava said, is less about the number of opt-outs as it is the number of people who are receiving services they want, whether that’s through original Medicare or through Cal MediConnect.

“We are excited that Cal MediConnect enrollment is continuing, and thousands of beneficiaries are joining Cal MediConnect plans, receiving health risk assessments, and being connected to the care and services they need,” Cava said. “Based upon the progress to date, it is evident that those who do wish to remain in original Medicare have the information they need to do so. Cal MediConnect is a voluntary program, and beneficiaries always have the option to opt out and return to original Medicare.”

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