State’s Dual Eligibles Initiative Under National Spotlight

Patient advocates across the U.S. are closely watching California's transition of beneficiaries eligible for both Medicare and Medi-Cal from traditional fee-for-service plans to managed care plans, Kaiser Health News reports.

Medi-Cal is California's Medicaid program.

Background

The California initiative is in its second year. State officials seek to transfer so-called dual eligibles to managed care plans to improve their health care services and reduce costs.

The state has estimated that the initiative will save $663 million next year and that it will yield additional savings in subsequent years.

Federal officials have begun implementing a similar national effort under a provision in the Affordable Care Act.

Benefits of Calif. Transition

Howard Kahn -- CEO of L.A. Care, the largest public health plan in the U.S. with one million members in Los Angeles County -- said the California initiative allows health plans to organize all of the care that dual eligibles receive and curb unnecessary treatments.

He said, "There's a whole bunch of really unnecessary care being delivered," adding, "Not only unnecessary, but inappropriate and fraudulent care."

Concerns With Calif. Transition

However, some patient advocates who have followed a California initiative that moved seniors and individuals with disabilities into managed care plans are concerned that similar tranfers could put patients at too great a risk.

A California HealthCare Foundation report on the initiative to transfer seniors and individuals with disabilities determined several problems with the process, such as:

• A short timeline that allotted the state only seven months between federal approval and when enrollment began;
• Privacy rules that prevent some health plans from receiving complete patient records;
• Transfer guidance that confuses certain patients about whether their preferred physicians participate in various managed care plans; and
• An appeals process that patients seeking exemption from the program find onerous.

CHCF publishes California Healthline.

According to Kaiser Health News, the transfer of seniors and individuals with disabilities caused some patients to leave trusted physicians and others to start receiving generic drugs that they say are ineffective.