Better coordination of care for beneficiaries with both the federal Medicare program and the state Medi-Cal program is one of the many goals within the Affordable Care Act (ACA). As part of meeting this outcome, California and 14 other states have received a federal grant to develop and implement a 3-year demonstration project to have dual eligibles (those with both Medicare and Medi-Cal) enrolled into a Medi-Cal managed care plan starting in 2013. The idea is to increase care coordination, reduce costs and enhance the dual eligible beneficiaries’ health care experiences. Advocates across the state, including CHA are closely watching this development and voicing our recommendations and alerts to make sure this transition is not detrimental, and instead is smooth and beneficial to the health of dual eligible beneficiaries.
One concern we’ve had is the state’s preference for both passive enrollment of beneficiaries into this program AND at least a one-year lock-in. This lock-in would mean that beneficiaries would have to stay in the Medi-Cal managed care plan for at least one year before having the option to “opt out” and return to Original fee-for-service Medicare and Medi-Cal or join a Medicare managed care plan. Another concern advocates have is the speed within which this massive program change is being planned for implementation.
Just last week federal health officials gave word that while the Centers for Medicare and Medicaid Services (CMS) does support passive enrollment, they do not support the state’s preference for a one-year lock-in. Instead they support passive enrollment with an “opt-out” provision that can be exercised at any time. They have also called for a 3-month delay in the official start date of the demonstration project, moving the date from March 2013 to June 2013.
CMS’ support of the “opt-out” provision is good news for dual eligible beneficiaries who, if the state heeds CMS’ recommendation, will be able to “vote with their feet” and determine whether they stay in their Medi-Cal managed care plan or not. It would provide more incentive to plans to do a good job in providing quality care.
The delayed start date is also good news. This is the 2nd delay, as the original start date was January 1, 2013, which was revised to March 2013 in the Governor’s May Revise. Many advocates, however, still feel that the start date should be when the state is ready for the program. If more time is required as the new start date approaches, more time should be granted to make sure the state “gets it right,” as this demonstration project will affect 1.1 million beneficiaries across the state.
Below are links to a couple articles on this topic, plus a link to project information on the California Department of Health Care Services (DHCS) website.
- CMS Weighs in on Enrollment Question
- What’s Best Enrollment Process for Dual Eligibles?
- Info from California’s Department of Health Care Services – Dual Eligibles Coordinated Care Demonstration