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Passive Enrollment Of Dual-Eligible Beneficiaries Into Medicare And Medicaid Managed Care Has Not Met Expectations.

Authors
  • Grabowski, David C1
  • Joyce, Nina R2
  • McGuire, Thomas G3
  • Frank, Richard G4
  • 1 David C. Grabowski ([email protected]) is a professor in the Department of Health Care Policy, Harvard Medical School, in Boston, Massachusetts.
  • 2 Nina R. Joyce is a postdoctoral fellow in the Department of Health Care Policy, Harvard Medical School.
  • 3 Thomas G. McGuire is a professor of health economics in the Department of Health Care Policy, Harvard Medical School.
  • 4 Richard G. Frank is the Margaret T. Morris Professor of Health Economics in the Department of Health Care Policy, Harvard Medical School.
Type
Published Article
Journal
Health affairs (Project Hope)
Publication Date
May 01, 2017
Volume
36
Issue
5
Pages
846–854
Identifiers
DOI: 10.1377/hlthaff.2016.1082
PMID: 28461351
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The Centers for Medicare and Medicaid Services Financial Alignment Initiative represents the largest effort to date to move beneficiaries who are eligible for both Medicare and Medicaid-known as dual eligibles-into a coordinated care model by the use of passive (automatic) enrollment. Thirteen states are testing integrated payment and delivery demonstration programs in which an estimated 1.3 million dual eligibles are qualified to participate. As of October 2016, passive enrollment had brought over 300,000 dual eligibles into nine capitated programs in eight states. However, program participation levels remained relatively low. Across the eight states, only 26.7 percent of dual eligibles who were qualified to participate were enrolled, ranging from 5.3 percent for the two New York programs together to 62.4 percent in Ohio. Although the exact causes of the high rates of opting out and disenrolling that we observed among passively enrolled dual eligibles are unknown, experience to date suggests that administrative challenges were combined with demand- and supply-side barriers to enrollment. These early findings draw into question whether passive enrollment can encourage dual eligibles to participate in integrated care models. Project HOPE—The People-to-People Health Foundation, Inc.

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