January 15, 2014
Starting this month, some elderly Californians who are insured through both Medicare and Medi-Cal ("dual eligibles") will be notified about their impending transition from fee-for-service into a new managed care program called Cal MediConnect. The Cal MediConnect program is a three-year demonstration for dual-eligible beneficiaries to receive coordinated care through a single managed care delivery system. 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.
A recent study conducted by UCLA Center for Health Policy Research's HOME project followed 37 of these dual eligibles and found that those who will be affected are often confused or concerned about the potential effects of any program change to their health care. Notices about the newest changes are just starting to be mailed out to consumers and most are not aware of the upcoming shift to managed care. But even when sent information about changes, the study found that this vulnerable group is often unable to fully understand the changes or act on options they are offered, particularly when they are in poor health or without family or other supportive resources.
The study documents how these elderly adults would like to receive information and recommends strategies that might smooth the transition. One strategy is the use of patient navigators, as done during implementation of the Affordable Care Act. These patient navigators would be specifically trained to respond to the needs of the dual eligible population and help them to understand their options under the program, including their right to opt out. This approach would be especially helpful for older adults who are less engaged and are likely to benefit from direct support.
For more information on the UCLA study, click here.
For more information on Cal MediConnect, visit www.calduals.org.
Contact: CMA’s reimbursement helpline, (888) 401-5911 or firstname.lastname@example.org.