Sociological Perspective on Dual Health Enrollment Challenges

This essay examines the reasons behind the low enrollment rates in dual health beneficiary programs, despite a significant number of eligible individuals. It identifies factors such as cost control measures, state decisions on healthcare laws, insufficient earnings for federal subsidiaries, and lack of access to specialists. Furthermore, the essay highlights the lack of awareness, cultural and social barriers, and inadequate mental health system integration as key issues preventing enrollment. Using the example of Virginia's low enrollment rates, the essay concludes that a combination of social, cultural, and awareness-related barriers contributes to the discrepancy between eligibility and actual enrollment in dual health beneficiary programs. Desklib offers a wide array of resources including solved assignments and past papers for students.

Running head: SOCIOLOGY
Topic: SOCIOLOGY
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1SOCIOLOGY
Medicare is the health insurance for people more than 65 years of age or certain
people under the age group and many patients suffering from end stage renal diseases. People
can receive their coverage through the original Medicare program and a Medicare advantage
plan. Similarly, Medicaid is another insurance program funded by the state as well as federal
government which pays for families with low incomes or limited resources (Cms.gov, 2019).
From the article, it can be seen that nearly 400,000 beneficiaries which are dually eligible
have been enrolled in financial alignment demonstrations. Furthermore, only 7% of dual
beneficiaries have been enrolled in Virginia (The Henry J. Kaiser Family Foundation, 2019).
Thus the essay would deal with the reasons people do not get enrolled in dual health
beneficiaries in spite of qualifying for both of them.
Controlling cost is one of the factors for not being enrolled in beneficiaries. The
expenses eventually reach higher rate during economic downturns due to loss of jobs and
health benefits of older people. Often control costs are reduced by cutting the payment rates
which ultimately reduces the benefits of the beneficiaries given to older people. Most of the
employees receive care through private managed care companies which often deal with the
issues of quality improvement and control costs. According to verdicts of Supreme Court in
2012, states have the independence of deciding to participate in the health laws which most of
the countries have refused. Thus most of the people have not received health insurance. Most
of the older people do not have sufficient earnings for qualifying for federal subsidiaries for
coverage on the health expenses even though a huge percentage of the people qualify for the
programs. According to studies, people not getting the facilities for dual beneficiaries’ often
do not receive specialists and dentists along with the care they should receive (Galewitz,
2019). Lack of knowledge is another factor affecting people in spite of being eligible. Most
of the people are not aware of the various advantages and coverage of the dual beneficiaries,
thus being dubious about their benefits. Moreover, cultural and social barriers are some of the

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issues preventing them from enrollment. According to lawmakers considering the present low
rates of enrollments in Virginia, the goal to save money and improve the care provided is not
being fulfilled due to the increase in people availing the facilities. Moreover, the structure of
the health system is inadequate as the mental health systems are not integrated for
introduction of beneficiaries in the current health system. Despite being the sixth state
approved for participation in the coordination of care for dual beneficiaries, a small
percentage of people are enrolled due to the aforementioned issues ("Virginia Demonstration
to Improve Dual-Eligible Care Is Approved by Federal Officials | Commonwealth Fund",
2019).
From the following paragraphs, it can be concluded that number of people being
eligible for dual beneficiaries are much higher than the number of people who actually enroll
due to various factors which are amalgamation of social, cultural barriers along with lack of
awareness about the matter.

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References
Cms.gov. (2019). Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-
Learning-Network-MLN/MLNProducts/downloads/
Medicare_Beneficiaries_Dual_Eligibles_At_a_Glance.pdf
Galewitz, P. (2019). 5 Challenges Facing Medicaid At 50. Retrieved from
https://khn.org/news/5-challenges-facing-medicaid-at-50/
Health Plan Enrollment in the Capitated Financial Alignment Demonstrations for Dual
Eligible Beneficiaries. (2019). Retrieved from https://www.kff.org/medicaid/fact-
sheet/health-plan-enrollment-in-the-capitated-financial-alignment-demonstrations-for-
dual-eligible-beneficiaries/
Jung, H. Y., Trivedi, A. N., Grabowski, D. C., & Mor, V. (2015). Integrated Medicare and
Medicaid managed care and rehospitalization of dual eligibles. The American journal
of managed care, 21(10), 711.
Van Cleave, J. H., Egleston, B. L., Brosch, S., Wirth, E., Lawson, M., Sullivan-Marx, E. M.,
& Naylor, M. D. (2017). Policy Research Challenges in Comparing Care Models for
Dual-Eligible Beneficiaries. Policy, Politics, & Nursing Practice, 18(2), 72-83.
Virginia Demonstration to Improve Dual-Eligible Care Is Approved by Federal Officials |
Commonwealth Fund. (2019). Retrieved from
https://www.commonwealthfund.org/publications/newsletter-article/virginia-
demonstration-improve-dual-eligible-care-approved-federal

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