Nursing homes blamed for high opt-out rates in dual eligible demo

Dually eligible beneficiaries are fleeing a test program.
Dually eligible beneficiaries are fleeing a test program.

A Centers for Medicare & Medicaid Services official said late last week it's too early to assess the success of a demonstration project aimed at reforming the costly system of caring for Medicare and Medicaid dual-eligibles, even as huge numbers of them are exiting the program.

After addressing the Medicaid and CHIP Payment and Access Commission, Tim Engelhardt, acting director of the CMS's Medicare-Medicaid Coordination Office, told reporters he's not concerned.

Critics of the plan complain cost-saving targets are nearly unattainable because participation is voluntary. Some states have reported high dropout rates, from 25% up to 45% in California. Only a little more than 340,000 of the 1.7 million dual eligible beneficiaries in 11 participating states had signed up as of April 1, according to Modern Healthcare. States blame most of the problem on nursing homes, claiming the providers don't understand how the program works, according to a Bloomberg news report. Most of the 9 million dual eligible beneficiaries in the country are low-income, elderly and disabled.

CMS established the Financial Alignment Initiative in 2011 under the auspices of the Affordable Care Act to study ways of improving benefit and care coordination of dual eligibles. To date, more than 65 health plans are reportedly participating in the project.

Engelhardt said formal evaluations of the demonstration project are expected the first half of 2016, and will be posted on CMS's website.

Last month, the Center for Medicare Advocacy took issue with a new study recommending Medicare Advantage rates be adjusted for dual-eligible patients because so many tend to have poorer outcomes than others. The study claimed that the current MA ratings system may not reflect the actual quality of care due to those patients' “significantly” worse health outcomes.