Passive Enrollment discussed at CPWD
CPWD held a Medicaid forum to hear directly from the state of Colorado about the Medicaid and Medicare Dual Eligibility Demonstration. The state is looking for ways to cut costs around this group of beneficiaries because they see the cost to the state as disproportionately high.
The most controversial point of the dual eligibility demonstration was the proposal to “passively enroll” people into the program. A letter would be sent to dual eligible beneficiaries that they must act on or they will be enrolled in the program. A beneficiary must actively respond to the letter to “opt-out” and keep services untouched.
Ian Engle, the CPWD Executive Director, pointed out the contradiction of passive enrollment with the Independent Living philosophy. He said that the Center promotes an informed individual to actively chose and direct their care. CPWD works so people decide and select services and supports so that they may take ownership and responsibility for the decisions they make.
Passive enrollment happens regardless of a choice and often without either clear knowledge or desire. An individual is forced to respond in order to opt-out of the program. Typically knowledgeable people act in their self-interest and those that do not act miss-out on the benefit. However, the state looks to turn this around so that the uninformed will be enrolled.
The state contends that someone may choose to opt-in or opt-out to the program at anytime and to be consistent with the current Colorado legislation they believe that passive enrollment is the only way to currently proceed. Teri Bolinger from the Colorado Health Care Policy and Finance Department was clear that passive enrollment was the only method on the table. Colorado citizens would have to demand a change for the state to consider another form of enrollment.
We asked the state to make the case why an individual would want to opt-into the program, but they could only repeat the advantages to the government agencies and providers. They implied that people would benefit from a more centralized control of programs and services and it is easy to see how this would benefit the state and possibly save money; but from the perspective of an individual recipient, there is no advantage.
I believe it is reasonable to opt-out until the state can show that their demonstration will actually work for you. It is essential that even creating an efficient and effective system that those impacted are informed and understand the services provided by the state.