Duals demonstration project delayed in three counties

December 12, 2013
Area(s) of Interest: Access to Care Advocacy 

The California Department of Health Care Services (DHCS) has delayed passive enrollment for three of the eight counties affected by the state's "pilot project" to redesign care for Medicare/Medi-Cal dual eligibles. The project in these three counties—Alameda, Santa Clara and Los Angeles—will begin instead with a voluntary period, during which patients can choose early enrollment with a Medi-Cal managed care plan, or wait until the automatic passive enrollment period, which will begin no earlier than July 1, 2014.

The project—known as Cal MediConnect—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 dual eligible beneficiaries transition to managed care plans. The project will impact approximately 450,000 duals in eight counties – Alameda, Los Angeles, Orange, Riverside, San Diego, San Mateo, San Bernardino, and Santa Clara.

There is no change to implementation date for the remaining five counties: Orange, Riverside, San Bernardino, San Diego and San Mateo. These five counties will begin passively enrolling patients in a managed care plan beginning April 1, 2014.

Once the passive period begins, individuals in all counties except San Mateo will be automatically enrolled over a 12 month period based on birth month. (San Mateo will have a hard start date of January 1, 2014, rather than a 12 month rollout.)

Patients have the option to select a specific plan of their choosing or to opt out of the project by notifying the state of this choice.

Alameda and Santa Clara will begin their three month voluntary enrollment April 1, 2014, with passive enrollment beginning no earlier than July 1, 2014. Los Angeles will begin its three monthly voluntary enrollment April 1, 2014, with passive enrollment start dates staggered depending on the plan. Health Net will begin passive enrollment no sooner than July 1, 2014, and LA Care will begin passive enrollment no sooner than December 1, 2014.

For more information, visit CMA Top Issues and www.calduals.org.

Contact: CMA’s reimbursement helpline, (888) 401-5911 or kmarck@cmadocs.org.


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