State ‘De-links’ Mandatory Enrollment from Duals Project

The Department of Health Care Services last week announced a new provision of Cal MediConnect that would establish a means of abandoning the state’s duals demonstration project  if it doesn’t meet a financial benchmark.

The department also wants to “de-link” mandatory enrollment from the demonstration project, according to Jane Ogle, deputy director at DHCS.

“On the program side, we de-linked mandatory enrollment of duals. That way, we’ll have long-term services and supports as Medi-Cal benefits,” she said.

Ogle, attending the annual conference of the California Association of Physician Groups in Los Angeles Saturday, said the department talked to stakeholders about the changes in a conference call Thursday. The call included explanation of a new financial insurance policy on the project.

“We have a revised poison pill [provision] so if the Department of Finance determines the program is not saving the state money, it can be terminated,” Ogle said. “Not just before the go-live in November or so, but then also every January, [the Department of Finance] would have the right to terminate the whole thing, it can all go away.”

It’s a just-in-case provision, she said, if something drastic should happen to federal funding or state finances. She mentioned reinstitution of the managed care organization tax as one of those variables.

The duals development was the talk of the CAPG conference, said Bill Barcellona, senior vice president for public affairs at CAPG. Most everyone is perplexed at the new provisions, he said.

“Everyone at this conference is talking about this,” Barcellona said. “I’m not sure we fully understand it yet.”

State and federal officials signed a memorandum of understanding in March that established the parameters of the Cal MediConnect demonstration project. Barcellona said that MOU should be binding.

“To me, an MOU is a contract. I don’t how, if you work out a contract between the feds and the state, how does the state Department of Finance suddenly get the right to unilateral termination?” he said. “That’s just not right.”

Barcellona said CAPG has been a longtime supporter of the duals project, but that these new changes could swing the group’s position.

In particular, he said, the new twists on the demonstration project include moving Medicare Advantage people into Cal MediConnect, and that makes no sense, he said.

“I don’t see why you’d take people out of Medicare Advantage, why you’d take people out of a program that works,” Barcellona said. “Our argument is, the purpose of the demonstration project is to put them in a coordinated system of care.”

Since Medicare Advantage already is a coordinated system of care, Barcellona said, the state would be moving people who don’t need the change.

“That’s just like what we experienced with Healthy Families, where you’re moving people who are already in a good system,” Barcellona said. “The question is: Are we going to add more lives, rather than just shuffle people on a ledger?”

There are about 1.1 million dual-eligible Californians — those people eligible for both Medi-Cal and Medicare. About 456,000 of them will be qualified to participate in the duals project, which spans eight counties and is scheduled to launch no sooner than October 2013.

The new mandatory enrollment provision, Ogle said, would not affect any of the consumer protections and benefits of Cal MediConnect — enhancements to the program that have been hammered out with stakeholders over more than a year of meetings, comments and revisions.

“All of those consumer protections we built into Cal MediConnect, those all remain the same,” Ogle said. “They’re built in. If we de-link them, it can all go straight to LTSS (long-term services and supports) as a Medi-Cal benefit.” 

The new provisions should not affect the launch of the demonstration project, Ogle said.

“We still think we’re doing the duals demonstration project, we’re going forward with that,” she said.

“This may not be as elegant a solution as the [original] Cal MediConnect plan. But we still think it’s going forward,” she said. “So if we can’t agree on something like the MCO tax then this is a choice.”

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Capitol Desk Medi-Cal Medicare