Update on Duals Demonstration
CMA received notice that beginning in January 2014 the state plans to mail notices to those beneficiaries who will be enrolled in the demonstration on April 1, 2014. Below, please see detailed information on the state’s plan and resources for physicians to help them through this transition.
Background
The 2012 budget authorized the Coordinated Care Initiative (CCI), which would allow persons eligible for both Medicare and Medi-Cal (dual eligibles) to receive medical, behavioral, long-term supports and services (LTSS), and home- and community-based services coordinated through a single health plan in eight counties (Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara). CCI contains two main components: (1) Cal MediConnect — transitioning individuals who are eligible for both Medi-Cal and Medicare (duals) away from fee for service and into managed care — and (2) Integration of long-term supports and services (LTSS) into managed care. The state plans to enroll approximately 450,000 dual eligibles into managed care in eight counties: Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara. Enrollment in Los Angeles County will be capped at 200,000. For detailed information on the project, click here.
Update
- In Orange, Riverside, San Bernardino, San Diego, and San Mateo, counties, passive enrollment into Cal MediConnect will occur on April 1, 2014. Those individuals with birthdays in April will receive notices in January that they will need to choose a Cal MediConnect plan.
- Individuals subject to passive enrollment in Cal MediConnect who decide to opt out of Cal MediConnect will still have to choose a Medi-Cal managed care plan, and their Long Term Support Services will be integrated into the plan.
- Enrollment will be phased in over 12 months in all participating counties, with the exception of San Mateo County, which will happen at all once during the first month. The remaining three counties (Los Angeles, Alameda, and Santa Clara) will not begin before July 1, 2014.
- In Los Angeles County, there will be a three-month voluntary enrollment period from April to July 2014. If the 200,000 enrollee cap is not reached within that three-month period, passive enrollment into HealthNet will begin no sooner than July 2014 (based on birth month) and passive enrollment into LA Care will begin no sooner than December 2014.
- The state plans on providing 90-, 60-, and 30-day notices to beneficiaries. The 60-day notice will contain a Health Plan Guide “choices” book that will have information about the health plan choices in that beneficiary’s county. Inside the “choices book” will be a “health plan choice form.” Beneficiaries can use this form to notify the state if they wish to make a choice other than the Cal MediConnect plan chosen for them through the assignment process. Beneficiaries also can call the toll-free number included in the notices to enroll or opt out.
Going Forward
- In order to assist physicians, CMA has created letters physicians can provide to their patients alerting them of their options.
- Please check the main Duals Demonstration site regularly for updates.