To Opt-In or Opt-Out? The Choice Behind Financial Alignment for Dual-Eligible Beneficiaries in Ohio.

Area of Science:

• Health Services Research
• Public Health Policy
• Healthcare Management

Background:

• The Financial Alignment Initiative (FAI) aimed to improve care coordination for beneficiaries eligible for both Medicare and Medicaid.
• Beneficiary opt-out from the Medicare component of FAI posed a potential challenge to its effectiveness.
• Understanding opt-in/opt-out patterns is crucial for evaluating such demonstrations.

Purpose of the Study:

• To examine the extent and impact of opting in or out of the FAI demonstration in Ohio.
• To identify demographic and service-related factors associated with opting out.
• To explore the challenges faced by care managers and providers due to beneficiary opt-outs.

Main Methods:

• Analysis of Ohio Department of Medicaid data (November 2021).
• Qualitative data from interviews with 36 organizations providing long-term services and supports or acute care.
• Descriptive statistics on opt-out rates across different age groups and service settings.

Main Results:

• 42% of dually eligible beneficiaries opted out of the FAI demonstration in Ohio.
• Higher opt-out rates were observed among long-stay nursing facility residents (51%) and younger age groups.
• Opt-outs led to reported challenges including lack of care access, poor communication, and difficulties during care transitions.

Conclusions:

• Beneficiary opt-outs from the FAI created significant barriers to coordinated care, particularly for those with complex conditions.
• These barriers limited the initiative's success in enhancing care quality and cost-effectiveness.
• Strategies to improve engagement and address opt-out reasons are needed for future demonstrations.