California adjusts Coordinated Care Initiative to address member confusion

California will no longer automatically re-enroll patients who are dually eligible for Medicare and Medi-Cal in managed care health plans during the final round of a three-year pilot initiative, according to California Healthline.

In the first two years of the state's Coordinated Care Initiative--part of a multi-state effort to improve care for dual-eligible beneficiaries--the program saw increased concern from members who were enrolled in plans without their knowledge and without a true understanding of what managed care meant. The federal government has had trouble reaching its enrollment goals for the program in some participating states.

Such is the case in California, where roughly half of all people who were chosen for the pilot have opted out of it, and another 10 percent have dropped out since enrolling during the first two years, the article says. Thus, the state is applying what it's learned by more clearly communicating the benefits of managed care plans with beneficiaries.

"They don't know the great care coordination they can get," Sarah Brooks, a deputy director at the Department of Health Care Services, tells California Healthline. "They don't know you can be in one consolidated program and you don't have to access services in multiple programs."

Now, beneficiaries will be able to stay with their Medicare doctors for one year before they switch to physicians in their new insurance plan's network. This is up from six months, and the longer time will give consumers more time to understand their benefits and will give plans and providers more time to develop relationships, the article says.

Even though the program will not automatically enroll eligible Californians, officials added they would consider reverting to automatic enrollment if not enough people sign up voluntarily.

To learn more:
- read the article

Suggested Articles

CMS approved a waiver from Nebraska to offer extra benefits to certain Medicaid beneficiaries in exchange for meeting work requirements.

Nearly 3 in 4 employers are planning to roll out new health delivery models in the next three years, according to a new survey.

Regardless of who wins the elections in November, there are three issues that are going to dominate the healthcare discussion in Congress in 2021.