New Doubts On Dual-Eligible Transition
Concerns about the pending transition of dual-eligible Medicare and Medi-Cal enrollees into managed care have been raised by researchers at UCLA, who believe that communicating the changes to an aging, often technology-challenged population could prove difficult.
About 460,000 dual-eligibles will be transitioned from fee-for-service into managed care coverage in eight counties starting in April as a cost-saving measure. Under the program, known as Cal MediConnect, many enrollees will have to change providers, which has the potential of causing confusion in a population that is aging – about 75% of the transition group is over the age of 65 – and often has cognitive impairment.
“This vulnerable group of consumers with multiple chronic illnesses and disabilities is unevenly responsive to the program information received, depending in large part on the older adult's physical or mental state and on the availability of family or other supportive resources,” said the authors of the report, which was issued by the UCLA Center for Health Policy Research.
Current dual-eligibles will be automatically enrolled into Cal MediConnect, and would have to officially declare their desire to remain in fee-for-service care.
“There is a concern that some enrollees could fall through the cracks,” said Kathryn G. Kietzman, the lead author of the study, if they do not make their declaration and are unaware their provider has changed.
The report, based on interviews with more than 50 dual-eligible enrollees and caregivers such as close family members, yielded a group of people with concerns about how they receive. Although they receive formal mailings from the Department of Health Care Services, which oversees the dual-eligible programs, many do not get their mail directly.
“Many report that they receive a lot of information in incidental ways, such as while speaking with other residents of their housing complex, while using transportation services, or while attending a community meeting or event,” the report read. It also noted that changes in prescription benefits are often discovered when medications are picked up and the copayments are higher.
Particularly vulnerable are patients who do not have a family members who helps take care of them, the report noted, sometimes making them want to give up.
“They want to shove us on managed care, and we would have no choice [about] who would come into our homes and be taking care of us,” said one 75-year-old patient who has terminal breast cancer. “To have someone step in, you know, and say ’This is what we are going to do,’ forget it. Just put me in an institution. That’s how strongly I feel about it.”
Although both Kietzman and the report praised the current outreach efforts of the DHCS, it recommended the agency use of health navigators with similar training to those helping uninsured individuals obtain coverage under the Affordable Care Act. Such navigators would provide the kind of personal communication considered important by the dual-eligible population. The report also suggested that the navigators make house calls to the sickest of the enrollees.
A spokesperson with the DHCS did not immediately respond to a request for comment on Wednesday.
