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Stakeholders Express Concerns About California Dual Eligibles Project

Brooke Phillips, CWCMS
Editor | Shield HealthCare
06/06/14  5:40 PM PST
California Dual Eligibles Project

California Dual Eligibles Project

Health care advocates, providers and patients have expressed concerns about a demonstration project for residents who are dually eligible for both Medi-Cal and Medicare, HealthyCal reports.

Medi-Cal is California’s Medicaid program (Woodall, HealthyCal, 5/8).

Project Background

The project, known as Cal MediConnect, is part of the state’s Coordinated Care Initiative.
Cal MediConnect integrates Medicare and Medi-Cal services and funding for Californians eligible for both programs. There are about 1.1 million dual eligibles in California.

State health officials hope that consolidating the funding and services from the two agencies will allow the state to deliver better, more integrated care at a lower cost (Gorn, “Capitol Desk,” California Healthline, 4/7).
The project took effect on May 1 and is expected to serve 460,000 California residents in eight counties, with the potential to expand statewide.

Of the four counties where the initiative already has been implemented, about:
· 300 have signed up in Riverside County;
· 300 have signed up in San Bernardino County;
· 300 have signed up in San Diego County; and
· 3,200 have signed up in San Mateo County.

Meanwhile, 3,000 people have opted out of the program.

Details of Concerns

Stakeholders have expressed concern about the new program, noting that participants could be forced to seek new providers if their current providers choose not to participate in a managed care plan offered by Cal MediConnect.

According to HealthyCal, counties will allow beneficiaries to remain with their current provider for six months to a year, even if their provider is not in the managed care plan. However, they will have to find a new provider if their current doctor chooses not to join the plan after one year. In addition, beneficiaries who do not take action will automatically be enrolled in a managed care plan.

In addition, some advocates and provider associations — including those that support Cal MediConnect’s goals — have said that the program’s implementation timeline should be longer and that the scope of the project should be reconsidered.
Deborah Pacyna, public affairs director for the California Association of Health Facilities, said, “From the provider standpoint, the complexity in the business office has been profound.”

State’s Response

State Department of Health Care Services spokesperson Anthony Cava said the project “represents many years of dedicated work” and is ready to be implemented.

He noted that an independent ombudsman is overseeing the project and other oversight measures have been put in place. He also said educational materials are available in several languages (HealthyCal, 5/8).

Source California Healthline

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