Stakeholders Assess Delayed Duals Project

by David Gorn

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The Department of Health Care Services last week delayed the launch of its duals demonstration project. Cal MediConnect, previously scheduled to start Jan. 1, is now slated to launch no sooner than April 2014.

Cal MediConnect aims to integrate Medicare and Medi-Cal services and funding for about one million Californians who are eligible for both programs. The duals demonstration project begins that process in eight California counties.

DHCS deputy director Jane Ogle, speaking at the department's quarterly stakeholder meeting for the duals demonstration project in downtown Sacramento, said the delay shows the state's good intention to implement this program in the proper manner.

"Moving the date to Apr. 1 really gave us all a breath," Ogle told stakeholders, "so we could make sure we have an opportunity to talk to beneficiaries, just about this project."

With the Medi-Cal expansion and the new health benefit exchange both starting in January 2014 -- and with eligibility and enrollment efforts beginning in October 2013 -- that created a potentially confusing scenario for dual-eligible Californians, according to Norman Williams, deputy director of public affairs for DHCS.  

"With all of the activity surrounding the implementation of Obamacare from October to January," Williams wrote in an email, "the delay ensures a quieter time for the state to discuss with dual eligibles their health plan options."

The state also has applied for a federal grant for an independent ombudsman program, Ogle said, to help monitor the state's efforts.

California HHS Secretary Diana Dooley said she expects the demonstration project will work well and expand to dual-eligible Californians in other counties.

"We don't think there's any mystery about what our intentions are," Dooley said. "We think it's a good concept, and as soon as we can, we want to expand this to as much of California as we can."

This pilot program is a little different than most, said Melanie Bella, director of the CMS Federal Coordinated Health Care Office, in that changes to the system can be made along the way, rather than waiting until the end of the demonstration time.

"The entire goal of this is to make real-time changes as we go," Bella said, using complaint lines, input from health plans and other types of monitoring data. "It's a nimble process. It enables us to make course corrections along the way."

But stakeholder Nancy Becker Kennedy of the In-Home Supportive Services Consumers Union had a different view of how this transition might go.

"Our people are medically frail. This number [of people in the duals project] is too large for this population," Becker Kennedy said. "The duals pilot is a good idea if it's a pilot, but … there are a multiplicity of issues still outstanding. Those glitches and bumps in the road are our lives."

Ogle said the department has not only heard those concerns, but has acted on them.

"In response to your concerns, we added the ability of people to opt out of the demonstration at any time," Ogle said. "IHSS hours will continue to be as they are today. We did hear you that the ombuds service should be independent, and that's why we went forward with it in that way with our ombuds grant."


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