Study: Dual Eligibles Worried About April Transition to Managed Care

UCLA researchers yesterday released a study that shows heightened concern and confusion among California seniors and the disabled over the state’s plan to move dual eligibles — Californians eligible for both Medi-Cal and Medicare — into managed care plans.

The duals demonstration project scheduled to start Apr. 1 is a central piece of the state’s Coordinated Care Initiative. The duals project will combine the financing and health care services provided by Medi-Cal and Medicare and integrate them into a managed care plan designed to offer more comprehensive services to beneficiaries at a lower cost to the state.

The study includes individual interviews with dual-eligibles affected by the impending program. Many beneficiaries are wary, according to researchers.

“These are big choices for anyone to make, let alone a choice that can be made by someone with cognitive problems,” said Kathryn Kietzman, principal author of the UCLA Center for Health Policy Research study.

“Not only will they have to choose [whether or not to opt out of the program] — if they realize they have to make a choice and have the wherewithal to choose — but once they do, they may have to deal with new providers,” Kietzman said. “This is a vulnerable population.”

State health officials are aware of the frail nature of this population, Kietzman said, which is one reason they have held innumerable meetings and hearings with stakeholders. The state several times has delayed the implementation of the duals demonstration project, now known as CalMediConnect, to make sure the transition goes as smoothly as possible.

“The goals of the state and the goals of the program are really great,” Kietzman said. “But it’s a big endeavor. It’s a paradigm shift.”

“The state’s been great about getting stakeholder input,” Kietzman said. “But we had a chance to sit down with the end recipient of this, the consumer. And observing how vulnerable most of them are, it’s clear [many of them] won’t be able to make those choices without some kind of help from the state.”

The study recommended a more personal approach to implementation, rather than relying on the mailed notices sent to beneficiaries — such as the use of patient navigators and coordination with community groups and with providers. That could offer a more familiar and welcome interaction for beneficiaries, Kietzman said.

In most counties, dual eligibles automatically will be enrolled unless they fill out a form to opt out of the program. “That’s where the rubber will hit the road,” Kietzman said. “In many cases, they won’t even know they’ve been transitioned. When services break down, that’s when those folks may be identified.”

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