A service of the California Health Care Foundation

New Lawsuit Filed To Block Duals Plan

Advocates for seniors filed a lawsuit in United States District Court in Los Angeles last week seeking an injunction to halt the Coordinated Care Initiative’s duals demonstration project, known as Cal MediConnect.

The project plans to move 456,000 seniors dually eligible for Medi-Cal and Medicare benefits into Medi-Cal managed care plans in eight California counties. That’s roughly half of the state’s population of 1.1 million dual-eligibles.

Time is short because the state is in the midst of sending notices of the possible change in medical plans, said Lynn Carman, one of the attorneys filing the suit on behalf of the Medicaid Defense Fund, a group of advocates and consumers including the Independent Living Center of Southern California.

Because California health officials are authorized to use a passive enrollment system, the people getting notices from the state will be shifted into managed care plans if they don’t respond, Carman pointed out.

“We are targeting the middle of next week to file an ex parte in federal court to get a fast hearing,” Carman said, “before they send out the next batch of notices on the 29th of September.”

Officials at the Department of Health Care Services, which is coordinating the duals effort, said the department isn’t allowed to comment on legal issues.

“DHCS policy requires us to decline comment on pending or ongoing litigation,” DHCS information officer Anthony Cava wrote in an email.

The lawsuit filed Aug. 29 said passive enrollment puts frail and elderly duals at risk, since there is often a gap in care during the time beneficiaries discover that, because they didn’t fill out a form or fill it out the way they thought they did, their health plan and physician have changed.

The complaint said, in part:

 “Auto-enrolled duals are disconnected during the transition period from all medical services, which injures and threatens to injure them, in violation of … federal due process right not to be injured from arbitrary and capricious government action…”

Carman said in an email that the duals population has a large percentage of Alzheimer’s and dementia patients, so they need to have their choices explained. They can’t be expected to have the wherewithal to not only understand the complicated forms but also fill them out properly and send them, he said.

“Basically, the state and CMS are engaging in a human experiment — without the dual’s written informed consent — to see what happens if a whole duals population is denied medical services for the period of the transition.”

A California Superior Court judge in Sacramento ruled Aug. 1 that the state was within its legal rights to continue the duals project implementation.

Categories: Capitol Desk, Medi-Cal, Medicare