Low-income and disabled Americans who are eligible for both Medicare and Medicaid are opting out at high rates from voluntary state initiatives aimed at better coordinating their coverage and care.
Dual-eligibles often have a difficult time navigating both programs to get the services they need. Even though the 9 million dual-eligibles make up only 13% of the population enrolled in both programs, they account for 40% of all Medicaid spending and 27% of Medicare spending. Experts say the lack of coordination makes their care far more costly.
Under the federal Financial Alignment Initiative, 11 states have launched or are about to launch three-year demonstration programs that pay insurers capitated rates to offer combined Medicare and Medicaid benefits. But the programs are voluntary for beneficiaries, and most 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 had opted out. In Massachusetts, out of 94,000 people who qualify for its One Care program, only 13,000 had signed up and 21,000 had opted out as of May 1. In Ohio, only about 9,000 of about 114,000 qualifying Ohioans have agreed to participate.
If low participation persists, it will be hard to evaluate the state initiatives, preventing them from being extended more broadly, said MaryBeth Musumeci, associate director of the Kaiser Commission on Medicaid and the Uninsured.