Duals Allowed To Designate an Assistant

Enrollment choices can be challenging, particularly for the 430,000 Californians in the duals demonstration project — people who often have cognitive issues such as dementia or Alzheimer’s.

Dual eligibles who need help in making those choices can now designate someone they trust as an enrollment assistant to make those choices for them.

Duals — people dually eligible for Medicare and Medi-Cal — are being automatically enrolled in Medi-Cal managed care plans in seven counties in an effort to better coordinate the financing and services of the two programs for beneficiaries. Duals in those counties have the choice to opt out of the conversion. 

The duals demonstration program is being implemented in Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo and Santa Clara counties. Five of those seven counties already finished passive (automatic) enrollment. Santa Clara and Orange counties are in the process now. Orange County started its passive enrollment effort Aug. 1.

Sarah Brooks, deputy director of health care delivery systems for the Department of Health Care Services, said assistants now have the option of making enrollment decisions.

“DHCS has continued to put the pieces in place to implement this change — ensuring that screening questions … are clear, and … staff are trained and prepared to respond to beneficiary questions,” Brooks wrote to stakeholders on Aug. 5. “We’re excited to report that this work is now complete and that enrollment assistants are able to … make enrollment decisions.”

According to Norman Williams, public information officer at DHCS, the enrollment assisters will help some seniors outside of the duals program, as well.

“This change primarily applies to frail beneficiaries who need assistance making enrollment choices. It is available for all Medi-Cal beneficiaries who make health plan enrollment or disenrollment choices through Medi-Cal call centers,” Williams said. “This includes Medi-Cal-only, partial dual-eligible beneficiaries, and dual-eligible beneficiaries.”

Kevin Prindiville, executive director of Justice in Aging, a senior advocacy organization, said the move will help the duals in the two remaining counties.

“We applaud DHCS for taking this important step to ensure that beneficiaries can get the assistance they need to make … enrollment decisions,” Prindiville said, “and we look forward to more policy changes that improve the way this new program serves low-income seniors and people with disabilities.”

“This is an important step for Medi-Cal beneficiaries who may need assistance with health plan enrollment or disenrollment for many reasons, including a cognitive disability, incapacitation, or other disabilities,” Williams said.

The enrollment assistant process is available to beneficiaries when they call Health Care Options, the call center for Medi-Cal- beneficiaries, Williams said.

“If the individual calling on behalf of the beneficiary is eligible to be their enrollment assistant, they will be able to utilize this process. We have also made our plan partners, ombudsman colleagues, Health Insurance Counseling and Advocacy Program (HICAP) organizations, and other stakeholders aware of this change so they can assist eligible beneficiaries in this process.”

Passive enrollment will continue in Santa Clara County until December 2015. Orange County’s enrollment goes until July 2016.

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Capitol Desk Medi-Cal Medicare