Duals Project Edges Closer to Completion

by David Gorn

TOPIC ALERT:

More than 300 people attended a Department of Health Care Services seminar yesterday offering details of the duals demonstration project, also known as the Coordinated Care Initiative.

The department recently released several reports, including a draft of the care coordination and long-term services and supports readiness standards. Those guidelines are a big step toward the state's readiness plan it eventually will need to submit to CMS, said Jane Ogle, deputy director of DHCS, at yesterday's seminar.

The state released a summary of some of the significant details in the reports:

  • The number of dual-eligibles in the demonstration project is now estimated to be 525,000 -- significantly fewer than the original estimate of about 700,000. According to the department, the lower estimate "reflects all the populations excluded, such as beneficiaries with developmental disabilities or without full Medicare benefits."
  • About a third of the 1.2 million dual-eligibles in the state are already enrolled in some form of managed care (Medicare Advantage or Medi-Cal managed care).
  • Almost half of the dual-eligibles (about 44%) have three or more chronic conditions.
  • More than half of the dual-eligibles speak a different primary language than English. The department said the most common languages are Spanish, Vietnamese, Armenian and Cantonese.

Dual-eligibles are eligible for Medicare and Medi-Cal. The initiative's goal is to mesh the two funding sources and patient services. State officials hope coordination will  improve quality of care and save money.

The three-year demonstration project is slated to begin June 2013 in eight California counties -- Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo and Santa Clara counties.

Public comment is being taken now on details of the draft care coordination and LTSS readiness standards.


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