Cal MediConnect Plagued By Opt Outs

Cal MediConnect has so far failed to connect with enrollees. UCLA researchers will soon delve into the reasons why.

The university's Center for Health Policy Research recently received a $400,000 grant from the Robert Wood Johnson Foundation to research to investigate why so many enrollees in the program intended to streamline care for dual-eligible Medicare/Medi-Cal beneficiaries have decided to opt out.

According to data from the California Department of Health Care Services (DCHS), 45% of Cal MediConnect enrollees have decided to leave the program, which combined their Medicare and Medi-Cal services into better coordinated coverage. Another 10% of enrollees have actively disenrolled after they were enrolled into the program passively from their existing health plans.

The numbers are a blow to DCHS, which had originally projected that no more than a third of CalMediConnect enrollees would leave the program. Dual-eligibles are among the most expensive enrollees in both Medicare and Medi-Cal to treat due to their advanced age and often impoverished living conditions. Both state and federal officials have been seeking more financially feasible and clinically effective ways to provide them care.

''It’s been a rocky start for Cal MediConnect, and the only way to find out why these consumers are opting out of the program is to ask them,'' said Kathryn Kietzman, a research scientist at the center and principal investigator of a new joint project, Consumer Healthcare Options Investigating Cal MediConnect Enrollment (CHOICE).

As part of the research, Kietzman and her colleagues will conduct 50 individual interviews and six group sessions with dual-eligible consumers and caregivers in Los Angeles County to glean their preferences and what driving their decisionmaking process. Los Angeles County residents make up about half of Cal MediConnect's 400,000 enrollees. Data from the studies is expected to be published sometime next year.

Cal MediConnect has been in pilot project stage in a half-dozen Southern California counties. The data from DCHS does not point to a specific reason as to why enrollees are leaving the program. The opt-out rate is relatively low among Latinos and other Spanish speakers, but much higher among other ethnic groups. Among Russians in Los Angeles County, for example, 92% have opted out, while 84% of those who are Vietnamese have opted out in Orange County. But in neighboring San Diego County, only 35% of Vietnamese have left the program.

Age also appears to be playing a role among opt-outs. In Los Angeles County, 63% of those enrollees age 90 and older are dropping out, but it drops to 48% among those age 21 to 64.

''It’s almost as if once a cluster of people made the decision to opt-out in a certain community, word spread and the rest followed suit,'' Kietzman said. ''It will be helpful to determine their source of information on managed care, how reliable it is and how it influences their decision to join or not join.''