California is in the midst of formulating a series of steps to move people eligible for both Medicare and Medi-Cal — known as dual eligibles — into a new managed care environment. Medi-Cal is California’s Medicaid program. The state is one of 15 around the nation to receive a federal grant to improve care coordination for the dual-eligible population.
Because dual eligibles are often heavy users of the health care system, the benefits of this shift could be significant for both beneficiaries and the state. Dual eligibles, who tend to have chronic health conditions and rely on services from numerous health care providers, could have their lives simplified and health outcomes improved through a more coordinated approach. In addition, the state could save money through better management and reduced costs with managed care, as compared with some fee-for-service care.
About 1.1 million people qualify for both forms of subsidized care in California — significantly more than any other state and about 13% of the nation’s dual eligible population. One goal of California’s demonstration project is to bring multiple kinds of care — behavioral health, social support, medical care and long-term coverage — under one administrative umbrella.
The state Department of Health Care Services, which is orchestrating the Duals Demonstration for Coordinated Care Delivery, seeks collaboration from counties, beneficiaries, health care providers, health plans and advocates.
Among the many organizational and administrative decisions the state faces in making this shift to managed care is how to enroll people in new coverage in which one entity is coordinating care. Because only a small number of dual eligibles already are in managed care in California, shifting the remainder will be a significant part of the project.
One of the key decisions the state faces is how to orchestrate that movement. At a basic level, there are two options — either beneficiaries choose or the state chooses. However, under either option — or a combination of both options — there are dozens of details and circumstances that make the issue much more complex than a simple “either-or” decision.
We asked policymakers and stakeholders to consider the pros and cons of various enrollment options — voluntary, mandatory, passive, active, opt-in, opt-out.
We got responses from:
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