Preparing for a new project, I’ve been exploring how Medicaid members who are concerned about the state’s shift to PCMH+, a risky, experimental payment model, can exercise their right to opt-out of the program. Advocates have been very concerned about the new program’s potential to incentivize denying people the care they need, shift less lucrative or difficult members out of care, and cost taxpayers more, as has happened in other states. The federally-required notice to consumers placed in the program a year ago was corrupted at the last minute to accommodate pressure from the health systems that could profit from the program. DSS’s own survey found that consumers are confused by the useless notice that now requires a college education to understand.
My odyssey began last week, February 8th, when I called the toll-free number in DSS’s consumer notice and pressed phone tree option #5 as directed. The recorded announcement says nothing about PCMH, PCMH+ or opt-ing out of the program. I dutifully worked my way through the other options, calling back in several times, finding nothing about PCMH+ or opt-ing out. I finally just finally pressed zero and was connected to a human being who said they don’t handle PCMH+ opt-outs anymore (don’t know when that changed, no notice was sent to consumers of the change) but she would check with her manager. After a few minutes, she came back to tell me that I needed to call the spend down unit. I said that makes no sense, they aren’t related programs but she insisted.
So I called that new toll-free number. Again, the recording said nothing (on February 8th) about PCMH+ or opt-ing out. I then methodically tried the options and found that a human answered #2. She asked a lot of questions about who I was, why I was calling, etc. but finally gave me the info for consumers to now opt-out of PCMH+. Just to add to the confusion, she only referred to the program as PCMH (no plus) which consumers do not want to (and would have no reason to) opt-out of. In fact, PCMH (no plus) is an exceptional person-centered program that provides coordinated care and saves money for the state without any risk of denying necessary care.
Interestingly I called both numbers again today, just a week later, as I planned to write this blog. The first number is unchanged but the second one does reference PCMH+ in the recording, alongside the spend down program. Unfortunately, no consumer would have any idea to call that number.
Needless to say, DSS’s claim that everyone must be happy with the program because no one is opt-ing out is disingenuous. They can’t set up a system making it impossible to opt-out and then use that to claim that the program is working.