Legislature Receives Final Plan for Duals Project

by David Gorn

TOPIC ALERT:

This was a big week for the state Department of Health Care Services, which on Monday submitted its final version of the strategic plan for the Coordinated Care Initiative -- a project in which the state eventually plans to move on million seniors and disabled "dual eligible" Californians to Medi-Cal managed care plans.

Dual-eligibles are eligible for both the Medicare and Medi-Cal programs. By meshing the two funding sources and patient services, the state plans to improve the quality of care while also saving money.

Initially, the duals demonstration project will start with eight California counties (Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo and Santa Clara counties) and the approximately 700,000 dual-eligibles in those counties.

"The final transition plan takes into account more than 160 pages of comments from 44 organizations and individuals," Jane Ogle, deputy director of DHCS, said when she announced the submission of the plan.

"This is an effort in eight counties across the state to integrate Medicare and Medi-Cal benefits, and coordinate care in a more effective way for a high-needs population," Ogle recently said at a long-term care summit in Sacramento.

"In those eight counties," she said, "people will have a choice of Medicare benefits -- but people will have to make a choice on a Medi-Cal plan."

If duals beneficiaries don't choose a Medi-Cal managed care plan, or opt out of the demonstration project, they would be passively enrolled in a plan.

"The transition won't begin till next June," Ogle said. "Between now and then, a lot of the talk will center on how we're going to ensure beneficiary protections throughout the program."

DHCS recently reached out to Medicare providers to explain that enrolling in Medi-Cal managed care doesn't change the Medicare reimbursement at all.

What many people don't understand -- including what many providers in California may not understand -- is that Medicare reimbursement remains the same in the duals demonstration project, Ogle said.

"This program is not an attempt to force Medicare into Medi-Cal managed care," she said. "It's an attempt to expand networks at these plans to include Medicare providers."

Ogle said that 15 states are undergoing dual-eligible transitions and that California has the largest effort. For many years, Ogle said, California seniors and individuals with disabilities have had fragmented and incomplete care, and she hopes to see that change.

"This is a demonstration project, that's certainly true," Ogle said. "But I think most people can agree that what's happening today doesn't work. Having 26 physicians doesn't work. Having pieces of services all over doesn't work. Making the quality and the access better, and bending the cost curve, that's what this is all about."


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