Reform Update: Many dual-eligibles opt out of care coordination

People who are eligible for both Medicare and Medicaid are opting out at high rates from voluntary state initiatives aimed at better coordinating their care. 

So-called dual-eligibles often have a difficult time navigating the policies of both programs to get the services they need. Caring for them is also significantly more expensive than for other beneficiaries in the programs, costing the state and federal programs about $350 billion a year. The 9 million dual-eligibles make up just 13% of the population enrolled in both programs but account for 40% of all Medicaid spending and 27% of all Medicare spending.

Under a provision of the Patient Protection and Affordable Care Act, the CMS Innovation Center invited states to launch three-year demonstration projects that would align care for dual-eligibles. Eleven states volunteered to participate and have launched or are about to launch programs that give health plans capitated payments to align care. But the programs are also voluntary for beneficiaries, and most of them are saying no.

In California, for example, only about 40,000 of the estimated 450,000 dual-eligibles had opted into the state's Cal MediConnect program as of July 1 and nearly 40,000 have opted out. The program began enrollment April 1. Massachusetts started enrolling residents in its One Care demonstration in October last year. Out of 94,000 people who qualify, just 13,000 had signed up and 21,000 had opted out as of May 1.

Go to top