Medi-Cal Transition 'Lessons Learned'

by David Gorn

TOPIC ALERT:

The Assembly Committee on Health oversight hearing yesterday on the many transitions of programs within the Department of Health Care Services was aimed at making sure shifts to Medi-Cal managed care plans are done with a maximum of consumer input and a minimum of disruption to Medi-Cal beneficiaries, according to committee chair Richard Pan (D-Sacramento).

"A significant concern of mine is to bring public transparency and accountability to the Medi-Cal managed care program," Pan said. "I recognize that DHCS has an active quality and accountability program -- however, it hasn't always been obvious to us and other stakeholders."

The transitions into Medi-Cal managed care include about 380,000 seniors and persons with disabilities and about 860,000 children in the Healthy Families program, in addition to the upcoming duals demonstration program and the rural expansion into Medi-Cal managed care.

With the implementation of the Affordable Care Act and the pending expansion of Medi-Cal coverage, the transparency and accountability so vital to all of those Medi-Cal managed care transitions could be compromised, Pan said.

"We want to make sure the ACA implementation doesn't interfere with our recent transition programs," Pan said. "Even as we're expanding Medi-Cal, we want to make sure we pay close attention to those people who are already in the Medi-Cal program."

DHCS Director Toby Douglas offered a long list of "lessons learned" that can help the department improve on previous transitions.

"There have been a lot of lessons learned. The first relates to engagement with stakeholders and legislators. We've learned a lot through our dual eligibles [demonstration project]."

The department conducted an extensive and ongoing series of stakeholder engagement events with the duals project, Douglas said, including webinars, workshops and large information-gathering stakeholder meetings.  

"With our SPDs (seniors and persons with disabilities), we didn't do enough of that," Douglas said. "As we look at other transitions, we want to make sure we have enough outreach."

Douglas said experience has shown the importance of several factors, including:

  • Getting patient data to the plans in a timely manner;
  • Ensuring more people understand they have the right to continuity of care;
  • Monitoring the performance of health plans; and
  • Improving outreach to providers.

"We want to have more engagement directly with providers," Douglas said. "We also have an ombudsman grant from CMS to do more work on that front."

Douglas took responsibility for missteps in utilizing the medical exemption review process during the transition of seniors and persons with disabilities.

"We made major mistakes as a department," Douglas said.

In particular, he said, DHCS needs to do a better job of informing beneficiaries about their right to a medical exemption review.

Vanessa Cajina, a legislative advocate for the Western Center on Law and Poverty, praised Douglas for his remarks and for the renewed commitment to patients' continuity of care, but said a lot of damage already has been done.

"Sadly that has come at the expense of the health of some of our beneficiaries," Cajina said.


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