Researchers, Health Officials Trying to Solve Dual Eligibles’ Opt-Out Puzzle

On Monday, health policy researchers at UCLA announced the launch of a project to better understand why such a high percentage of seniors have been opting out of joining the Cal MediConnect program, part of the state’s duals demonstration project and Coordinated Care Initiative.

Last week state health officials took a step toward reversing the opt-out numbers by releasing a draft proposal for its Cal MediConnect Beneficiary Toolkit, designed to answer questions seniors might have about their choices within and without Cal MediConnect.

There are about a million Californians who are dually eligible for benefits under both Medi-Cal and Medicare. The duals demonstration project has targeted about 430,000 of those duals in seven California counties in an attempt to better coordinate their care and possibly save the state money by combining the services and resources of both programs.

In those seven demonstration counties the state has been automatically enrolling dual eligibles in Cal MediConnect if they don’t make a choice to opt out, a process known as passive enrollment. The state originally expected up to a third of potential enrollees to opt out, but the opt-out rate  has been much higher than that, at about 45% — and it has hit 66% in some counties.

“It’s been a rocky start for Cal MediConnect,” said Kathryn Kietzman, research scientist at UCLA’s Center for Health Policy Research and lead investigator for the new project, in a written statement. “The only way to find out why these consumers are opting out of the program is to ask them,” she said.

The new research project is being called Consumer Healthcare Options Investigating Cal MediConnect Enrollment — CHOICE. It is funded by a $400,000 grant from the Robert Wood Johnson Foundation.

State officials are hoping their proposed Cal MediConnect Beneficiary Toolkit, which was released Nov. 24 as a draft that still needs stakeholder review, will answer basic questions dual-eligible beneficiaries might have, such as whether or not they can keep their doctor if they make the switch to Cal MediConnect.

“This toolkit will help eligible beneficiaries understand their options and how Cal MediConnect may benefit them,” said Sarah Brooks, deputy director of health policy systems at the Department of Health Care Services, in a written statement announcing the proposed toolkit. “It will also help these beneficiaries better understand how to navigate their Medi-Cal managed care plans if they do keep their Medicare as the same,” she wrote.

Amber Cutler, staff attorney at the Los Angeles office of Justice in Aging, a not-for-profit senior advocacy and legal aid organization, has long advocated for more and clearer information for the dual eligibles in the seven demonstration counties.

“We are happy to see that [the Department of Health Care Services] is working on materials to better explain the Cal MediConnect program and the confusing myriad of choices dual-eligible beneficiaries face when it comes to making a decision about how they want to receive their benefits,” Cutler said in an email.

“This is critical for dual eligibles who have multiple chronic conditions and low health literacy,” Cutler said. “We see this new toolkit as an opportunity to further educate and empower beneficiaries to make informed choices.”

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Capitol Desk Medi-Cal Medicare