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Duals demonstration passive enrollment effective August 1 in Orange County

May 05, 2015

Passive enrollment for the Medicare/Medi-Cal duals demonstration will begin on August 1, 2015, in Orange County. If patients do nothing, they will automatically be enrolled in CalOptima for their Medi-Cal and Medicare benefits. The California Department of Health Care Services (DHCS) reports most of these patients are already enrolled in Cal Optima for their Medi-Cal benefits. Affected patients will be notified by CalOptima 90, 60 and 30 days prior to their enrollment date. A brochure will be released in conjunction with the 60-day notice. Individuals will be automatically enrolled over a 12-month period based on birth month.  


CalOptima reports that contract amendments to include the duals product were sent out to all of its currently contracted physicians in late March.


While the dual eligible patients in affected areas have the choice to opt out of the Medicare managed care plan and stay in fee-for-service Medicare, there is no ability to opt out of enrollment in CalOptima, Orange County’s only Medi-Cal managed care plan.


Additional information on populations who are mandatorily enrolled and do not have the ability to opt out of a Medicare managed care plan can be found on the Cal Duals website (exempt populations indicate “exempt from passive enrollment”).


The demonstration—known as the Coordinated Care Initiative (CCI)—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. The project was expected to impact approximately 450,000 duals in eight counties – Alameda, Los Angeles, Orange, Riverside, San Diego, San Mateo, San Bernardino and Santa Clara. However, in November 2014, DHCS announced CCI would not move forward in Alameda County, bringing the total possible enrollment into the program to approximately 430,000. The decision, made with input from local stakeholders, was based on concerns with the financial solvency of Alameda Alliance for Health, the CCI plan in Alameda County.


The California Medical Association has also created a visual timeline of the implementation dates by county. Also available on our website are sample patient letters. Physicians may wish to proactively send these letters to their dual eligible patients so that patients will know the plans and medical groups you contract with, so they can select appropriately at enrollment time.


DHCS has created a Physician Toolkit that includes answers to frequently asked questions about Cal MediConnect that is available on the Cal Duals website at www.calduals.org/physician-toolkit.

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