Dual-Eligible Coordinated Care Program Gets Vote of Confidence in Gov.’s Budget

On Thursday, the Coordinated Care Initiative got a little boost when Gov. Jerry Brown released his 2016-17 budget proposal.

The CCI duals demonstration project — a seven-county pilot program that combines the funding and services for those Californians dually eligible for Medi-Cal and Medicare — had been skating on thin ice, as its existence has been tied to being cost-effective.

Achieving cost neutrality was, in part, dependent on strong enrollment in CCI’s Cal MediConnect. That hasn’t happened. The opt-out rate and “disenrollment” rate for the program have been much higher than expected.

Thursday’s inclusion of CCI in the budget proposal was a strong vote of confidence in the program, said Susan DeMarois, state public policy director at California Council of the Alzheimer’s Association.

“I’m so pleased with that, [this program] has so much potential for long-term savings,” DeMarois said.

The cost-effective requirement still is in place and dependent on the replacement of the $1.1 billion MCO tax (managed care organization tax), which expires in June. And the state’s share of savings from the program have dropped originally the state expected to split savings 50-50 with CMS, but that share has been shaved to 25 to 30% by the feds.

Even with those caveats, the state clearly made a statement about the viability of the CCI program with its inclusion in this budget proposal, DeMarois said.

“The enrollment numbers will climb slowly and steadily,” DeMarois said. “This is a population we work with all the time and … we know from experience there’s a lot of resistance to change, there’s a lot of loyalty and fidelity to [beneficiaries’] physicians.”

That wariness about the program is slowly changing, she said — among health plans, physicians and consumer advocates, as well as beneficiaries.

“When it was new no one heard of it,” DeMarois said. “People are taking another look at it now. Especially in the provider community, they have more confidence in it. I mean, it was new for them as well as beneficiaries. But … the goals of the program are laudable. And when it works, it works very well.”

If CCI is not cost‒effective, it would automatically cease operation in January 2018. But for now, CCI has the endorsement of the Brown administration. The Legislature, governor and health plans will try to work out the details of the revised MCO tax — and the state will attempt to shift enrollment patterns among the dual eligibles in the demonstration counties.

Categories: Capitol Desk