State Tweaks Timeline for Duals Project

State health officials last week dropped Alameda County and its 26,000 dual-eligibles from Cal MediConnect, California’s demonstration project for Californians eligible for Medi-Cal and Medicare.

The timeline for Orange County was pushed back one month for automatic enrollment to start. Orange County had already been delayed to start no sooner than July 2015 because of federal concerns about the oversight readiness of the CalOptima health plan. Enrollment still will begin in July 2015, but passive enrollment — in which beneficiaries are automatically enrolled if they do nothing — now will not begin until August 2015.

Cal MediConnect started with federal approval to target a pool of 456,000 dually eligible seniors in eight demonstration counties. It’s part of a larger effort called the Coordinated Care Initiative. The Department of Health Care Services, which oversees CCI and the duals project, wants to combine services and financing of Medicare and Medi-Cal with the goal of offering more complete, integrated services while saving the state money at the same time.

With the exclusion of Alameda County, the pool of beneficiaries dips to 430,000 duals in seven counties.

Due to financial difficulties earlier this year, Alameda Alliance for Health was put under the supervision of a conservator by the state’s Department of Managed Health Care. Those financial issues led to a joint decision to remove Alameda from the duals project, said Mari Cantwell, chief deputy director of health care programs at DHCS.

“This was a joint decision with the Department of Managed Health Care and the [Alameda Alliance] board of governors, as well as providers and stakeholders,” Cantwell said. “Everyone thought this was the best course of action, so they can focus on the populations they’re already caring for.”

It takes a significant amount of work to prepare for an effort like the duals project, Cantwell said.

“And that is not the best thing to be focusing on now for Alameda Alliance,” she said.

The decision to delay passive enrollment in Orange County for another month is primarily a logistical one, Cantwell said. The audit report from CMS may not be out in time to properly launch passive enrollment, she said.

“We’ve already done our audit [of CalOptima], but we’re not sure of the exact timing of their [federal] audit report, and at some point we have to decide whether it’s a go or a no-go for notices,” Cantwell said.

Delaying a month builds in an important cushion of time, she said.

“It’s not a flip of the switch to send out notices, so to make sure nothing goes awry we are just being on the safe side,” Cantwell said.

Moving cautiously is what drove the decision to exclude Alameda County from the duals demonstration project, she said. That sentiment was echoed by Shelley Rouillard, director of the Department of Managed Health Care.

“The DMHC’s priority has been and continues to be to bring Alameda Alliance into a healthy financial condition and to transition it back to local control,” Rouillard said. “[The] decision to not proceed with the implementation of the CCI in Alameda County will enable the plan to focus on serving its current enrollees while working to improve and stabilize its financial status.”

The conservatorship of Alameda Alliance for Health is scheduled to end on July 23, 2015.

Categories: Capitol Desk, Medi-Cal, Medicare