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Pilot programs for dual-eligibles struggle with enrollment

Yet some states' Medicare-Medicaid coordination efforts have paid off

The federal government is having trouble reaching its enrollment goals for a program aimed at improving care and lowering costs for those eligible for both Medicare and Medicaid, The Wall Street Journal reports.

A dozen states joined with the Centers for Medicare & Medicaid Services in 2014 for a three-year pilot program with the goal of aligning Medicare and Medicaid services for dual eligibles, FierceHealthPayer has reported. To achieve this, participating states integrated major aspects of the programs, including finances, delivery of benefits and overall experience.

Socioeconomic disadvantages often cause dual-eligibles to have poorer health outcomes than the population at large, research has shown, highlighting the need for better care coordination to combat health disparities.

But despite the promise of the government's demonstration program, enrollment in the nine states where numbers are closely tracked show three consecutive months of modest decline as of Dec. 1, according to the WSJ's analysis of government data. And in all 12 states, about 34 percent of the nearly 1.4 million dual-eligible individuals have joined the pilot programs, a figure lower than insurers, state officials and analysts expected, the article notes.

Part of what may be driving lower-than-expected enrollment are dual-eligibles' concerns about losing their provider networks if they switch coverage, the WSJ adds. Indeed, a recent survey found that 84 percent of those who opted out of Cal MediConnect--California's Medicare-Medicaid coordination effort--said they did so because they were satisfied with their current healthcare services, while 71 percent didn't want to risk losing their doctors.

Despite their struggles, though, the states' pilot programs have made some progress, according to the article. For example, a Vermont program that pairs part-time wellness nurses and health coordinators with elderly public housing residents has shown in early results that it can slow Medicare spending. In addition, Tim Engelhardt, director of the Federal Coordinated Health Care Office told the WSJ that despite some setbacks, overall enrollment results were "really positive."

To learn more:
- read the article
- access the CMS data

Related Articles:
States aim to improve health needs of dual-eligibles
Socioeconomic hardships hurt dual eligibles' health outcomes
Connect behavioral and medical health to better serve dual eligibles
CMS working on star-rating system for Medicare-Medicaid plans