Advocates Ask for Delay in Duals Project

Advocates for seniors and the disabled sent a strongly worded letter to federal and state officials Friday calling for a temporary halt to California’s duals demonstration project in seven of the eight pilot counties.

“We write to urgently request the suspension of implementation of the Coordinated Care Initiative in all counties other than San Mateo until the Department of Health Care Services and the Centers for Medicare and Medicaid Services can demonstrate that an enrollment process is in place that provides seniors and people with disabilities the information and resources they need to make informed decisions about their Medicare and Medi-Cal benefits,” the letter said.

The CCI aims to coordinate care and financing of care for the estimated 1.1 million Californians eligible for Medicare and Medi-Cal. The demonstration project plans to automatically enroll almost have of them — about 456,000 — in managed care plans beginning April 1. Unless beneficiaries specifically opt out, they will be moved into the program in a process known as passive enrollment.

There have been many complications in the plan. CMS officials found a number of problems in its readiness review of CalOptima, the only participating health plan in Orange County (the second-largest duals population in the state). The launch of passive enrollment was delayed till 2015. In Santa Clara County, which has had “difficulties with a system implementation,” according to DHCS officials, also won’t start till 2015.

Three other counties — Riverside, San Bernardino and San Diego — are set to start passive enrollment May 1. Two counties — Alameda and Los Angeles — are scheduled for passive enrollment efforts July 1. 

San Mateo County is the only one to meet the original April 1 launch deadline.

The potential confusion from the staggered county startups, along with concerns about health plan readiness and the potential inability of beneficiaries to opt out of the duals demonstration project, all led a group of six not-for-profit advocacy groups on Friday to urge state and federal officials to suspend most of the duals project for now.

The six signees of the letter were California Health Advocates, Disability Rights California, the Disability Rights Education and Defense Fund, the National Health Law Program, the National Senior Citizens Law Center and the Western Center on Law and Poverty.

“Many key aspects of the CCI simply are not ready, including most notably notices, internal DHCS and CMS systems, and the demonstration’s enrollment broker… ,” the letter said. “Both agencies promised that enrollment would not proceed unless systems were ready. Those promises need to be kept.”     

Specifically, advocates are asking for a halt to roughly 92,000 60-day notices scheduled to start going out to dual-eligibles in Riverside, San Bernardino and San Diego counties at the end of this week.

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