California encountered several problems during a year-long effort to transition 240,000 Medi-Cal beneficiaries from fee-for-service to managed care plans, according to a report by the California HealthCare Foundation, Kaiser Health News' "Capsules" reports.
CHCF publishes California Healthline. Medi-Cal is California's Medicaid program.
The federally approved demonstration project involved 240,000 low-income seniors and people with disabilities.
The Medi-Cal beneficiaries either selected a managed care plan or had one assigned to them by the state (Carey, "Capsules," Kaiser Health News, 9/4).
CHCF conducted several surveys and interviews to assess the effectiveness of the transition (Herman, Becker's Hospital Review, 9/4).
According to the report, caregivers and other respondents said that "the managed care system ... was not prepared" to address beneficiaries' specific needs, which involved mental illness, developmental disabilities and homelessness.
The report found other problems during the shift, including that:
- Beneficiaries "experienced anxiety due to confusion and concern over whether or not they would still be able to see their current primary care physician, specialists and mental health providers," as well as those who provided their prescriptions and medical equipment;
- Beneficiaries struggled to understand complex written materials they received, and fewer than half of health plans offered support to beneficiaries by telephone;
- Health plans did not offer information and care coordination early enough in the process, according to stakeholders; and
- Health plans reported out-of-date contact information for many beneficiaries and said they had difficultly recruiting fee-for-service providers to their networks.
Christopher Perrone -- deputy director for CHCF's Health Reform and Public Program's Initiative -- said, "What we heard again and again from those who were surveyed for this study was that a much more extensive and personal education and outreach strategy was needed."
He added, "Once you have the policy set, you have to make sure there is sufficient time to reach out to the provider community, to convey what those policies are and what the transition means to them."
CHCF released the report as CMS is developing plans to move many of the nine million U.S. residents eligible for both Medicare and Medicaid -- known as "dual eligibles" -- into managed care plans.
Although some officials and lawmakers have criticized CMS for moving too quickly to transition the beneficiaries, the agency said that it recognizes "how critical it is to have beneficiary protections in place to achieve the highest-quality health care possible" ("Capsules," Kaiser Health News, 9/4).