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LACMA files lawsuit to stop duals program



July 09, 2017
Area(s) of Interest: Access to Care Advocacy Payor Issues and Reimbursement Public Payors 

On July 2, the Los Angeles County Medical Association (LACMA) joined a coalition of plaintiffs, including three Los Angeles independent living centers to file a lawsuit in Sacramento Superior Court to stop the state's Cal MediConnect program for Medicare/Medi-Cal dual eligibles.

The Cal MediConnect project 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 begins with a three-year demonstration project that would see a large portion of the state's beneficiaries under Medi-Cal and Medicare (known as dual eligible beneficiaries) transition to managed care plans. The project will impact approximately 456,000 dual eligible beneficiaries in eight counties – Alameda, Los Angeles, Orange, Riverside, San Diego, San Mateo, San Bernardino, and Santa Clara.

The lawsuit alleges that Cal MediConnect is not legally authorized because the Department of Health Services (DHCS) failed to obtain timely federal approval of the demonstration project as required under the state law establishing the project. If the plaintiffs prevail on this claim, a court potentially could invalidate the entire project unless and until the Legislature reauthorizes the project with new legislation.

The lawsuit alleges that there are deep flaws with the implementation of the project thus far, including problems with the notices to beneficiaries and the enrollment form. Specifically, the lawsuit alleges the notices were not written at a 6th grade reading level as required by law. In addition, the enrollment form is too confusing to meaningfully provide an opt-out choice for beneficiaries. If the plaintiffs prevail on one or more of these claims, a court could delay the implementation of the project until these problems are fixed.

The California Medical Association (CMA) is not a named party in the lawsuit. However, CMA believes the lawsuit raises legitimate issues about the rollout and implementation of Cal MediConnect, specifically concerning adequate notice and information to affected beneficiaries and providers. These issues warrant a fair and quick resolution by the court.

CMA has been working constructively with DHCS and other stakeholder groups to identify problems and fixes in the Cal MediConnect implementation and rollout. We will continue to work with DHCS in an attempt to improve implementation of the Cal MediConnect program.

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