Temporary injunction in Cal MediConnect case denied

August 07, 2014
Area(s) of Interest: Licensing & Regulatory Issues Public Payors 

Last week, the Sacramento Superior Court denied a request to delay implementation of the Cal MediConnect project. 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 implementation of the project.

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 will see a large portion of the state's Medicare/Medi-Cal 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.

Petitioners alleged that Cal MediConnect is not legally authorized because DHCS failed to obtain timely federal approval of the demonstration project as required under the state law establishing the project. Second, it was alleged 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, it was alleged the notices were not written at a 6th grade reading level as required by law and in addition, the enrollment form is too confusing to meaningfully provide an opt out choice for beneficiaries.

The California Medical Association (CMA) was not a named party in the lawsuit. However, CMA believes the petitioners raise legitimate issues about the rollout and implementation of Cal MediConnect, specifically concerning adequate notice and information to affected beneficiaries and providers. An appeal in this matter is expected in September.

In an unrelated move, the Department of Health Care Services (DHCS) has delayed the implementation of the Cal MediConnect project for Alameda and Orange counties until July 2015.

CMA will continue to work with DHCS and other stakeholder groups to identify suggestions for improvement in the Cal MediConnect implementation and rollout.


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