CMS Disallows

CMS Disallows "Lock-In" of Dual Eligibles in Managed Care Programs

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CMS Disallows "Lock-In" of Dual Eligibles in Managed Care Programs

June 15, 2012

The Centers for Medicare & Medicaid Services (CMS) has said that states may not lock beneficiaries who are dually eligible for Medicare and Medicaid into managed care programs for fixed periods of time. Some states, including California, have proposed lock-in periods for dual eligibles as part of demonstration programs designed to integrate care for this population.

Though no official guidance has been issued from CMS, a letter was sent last summer by CMS to state Medicaid directors that took a position against locking in beneficiaries for any set length of time. The demonstration model also allows for automatic enrollment of dual eligibles, which has drawn criticism from some beneficiary advocates who note that such automatic enrollment may cause beneficiaries to have to change providers and that the new providers may not adequately meet their needs.

In a letter dated June 11, 2012, certain members of the Senate Committee on Finance wrote to CMS encouraging CMS to retool its duals demonstration programs to limit their size and scope, and open the contracts selection process to greater market competition.