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DHCS suspends planned passive enrollment for duals project



May 24, 2016
Area(s) of Interest: Payor Contracting Payor Issues and Reimbursement Practice Management 

The Department of Health Care Services (DHCS) announced last week that it would not move forward with its planned annual passive enrollment of dual eligible beneficiaries under the Coordinated Care Initiative (CCI) after it received feedback from the California Medical Association (CMA) and 40 other stakeholders asking the agency to pursue enrollment strategies that support voluntary "opt-in" enrollment.


Instead, DHCS said it will implement a voluntary "opt-in" enrollment effort beginning in July 2016. The new streamlined enrollment strategy will include mandatory Managed Medi-Cal Long-Term Supports and Services (MLTSS) plan enrollment. DHCS said it would monitor participation in the program; should voluntary enrollment not prove to be a viable option for program sustainability, passive enrollment remains an option in the future.


In April, DHCS released a series of proposals that would have changed the CCI enrollment process to 1) passively enroll beneficiaries into Cal MediConnect; and to 2) streamline enrollment by allowing plans to eliminate or dramatically reduce the role of the enrollment broker.


CMA, in partnership with Justice in Aging and other patient advocacy groups, signed a joint letter strongly opposing the proposals.


“Experience shows that passive enrollment strategies result in high opt-out rates, confusion, disruption in care, distrust of managed care and high costs to plans,” the letter to DHCS said. “(P)assively enrolling over 100,000 beneficiaries in a two-month period is staggering. The plans, HICAPs, Ombudsman, enrollment broker, and the broader community lack the capacity to meet the needs of the affected beneficiaries, especially on the expedited timeline DHCS has proposed, under which the first set of notices would be mailed to beneficiaries.”


The Coordinated Care Initiative was authorized by the state in July 2012 in an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities. The program began with a three-year demonstration project that expected to see a large portion of the state's dual eligible beneficiaries transition to managed care plans.


Although the state is not going forward with passive enrollment in 2016, DHCS has stated they are still considering a passive enrollment strategy for 2017.



Contact: Lishaun Francis, (916) 551-2554 or lfrancis@cmadocs.org.

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