Duals Demonstration Passive Enrollment Has Begun
[ SDCMS MEMBERS & STAFF: CLICK HERE TO WATCH OUR MAY 1 SEMINAR "CAL MEDICONNECT: WHAT YOU NEED TO KNOW" ]
Passive enrollment for the Medicare / Medi-Cal duals demonstration began on May 1 in San Diego, Riverside, and San Bernardino counties. If patients do nothing, they will automatically be enrolled with a managed care plan for their Medicare and Medi-Cal benefits. Affected patients have been notified by the California Department of Health Care Services 90, 60, and 30 days prior to their passive enrollment date.
Patients do, however, have the option to select a specific plan of their choosing. While the dual-eligible patients in affected areas have the option of opting out of a Medicare managed care plan and staying in fee-for-service Medicare, there is no ability to opt out of enrollment in a Medi-Cal managed care plan. (For more information on opting out, click here.)
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 had a hard start date of January 1, 2014, rather than a 12-month rollout.)
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.
The California Medical Association (CMA) has also created a visual timeline of the implementation dates by county. Also available on CMA's 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.
For more details on Cal MediConnect, visit http://www.cmanet.org/duals.