"Opt In" or "Opt Out"? Clarification

Opt-in Opt Out

At our Preparation meeting on Thursday January 16, 2013, there was some disagreement over the use of the terms “Opt out” and “Opt In”.  Here in NM we have been using the term “opt out” or "Opt Out Category" to describe the way our Native American population utilizes Medicaid.  The NA population is automatically “opted out” of Managed Care when they apply and are approved for the Medicaid program.  After being approved for Medicaid Services a Native American individual has the personal choice to then “opt in” to a Managed Care Organization (MCO) to administer health services (Molina, Presbyterian, Blue Cross Blue Shield, and Lovelace).

Here is the confusion, NMHSD and CMS use “Opt out” to describe the individual enrollees’ choice to “opt out” of Managed care, after being automatically enrolled into Managed care.  For Example Kansas has an “Opt out” provision in their Medicaid program.  Their Native American Population is Automatically Enrolled in Managed Care and given the personal choice to “Opt Out. 

“Opt in” describes the individual enrollees’ personal choice to “Opt In” to a MCO, after having been automatically excluded from mandatory participation in a MCO.  This is currently the way Medicaid functions in NM for its NA population.

The Terms “Opt Out” and “Opt In” is defined differently depending who are using them.  The workgroup has determined that for the upcoming Consultation with CMS that we (NA representatives) use the term “opt in” due to the fact that it best describes the manner in which we want Medicaid to continue for our Native American communities an individuals.

It is important that we are clear about the terms that we use.  We want to keep the way we enroll in Medicaid to stay the same.  We want all Native Americans to be automatically excluded from the mandatory enrollment into a MCO, and be given the personal choice to “Opt In” to Managed care.