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Duals Demonstration Project Begins

The duals demonstration project launched last week in five counties, according to officials from the Department of Health Care Services, which is overseeing the project.

Only one county has launched the automatic process — known as passive enrollment — that moves beneficiaries into new coverage. In San Mateo County, residents who are dually eligible for Medicare and Medi-Cal and who do not choose the Medi-Cal fee-for-service option will be automatically — or passively — enrolled in Medi-Cal managed care.

Three other counties (Riverside, San Bernardino and San Diego) will begin passive enrollment next month.

Los Angeles County is slated to start passive enrollment in July, though LA Care, one of the larger providers in the county, will not passively enroll dual eligibles until January 2015. LA Care passed its CMS readiness review so the insurer is able to accept dual eligibles who voluntarily enroll, but LA Care’s low marks in the CMS star rating system will prevent it from automatic enrollment till 2015.

Three other counties — Alameda, Orange and Santa Clara — are scheduled to participate in the project starting in January 2015.

The duals demonstration project, known as Cal MediConnect, is part of the state’s Coordinated Care Initiative.

Cal MediConnect plans to integrate Medicare and Medi-Cal services and funding for Californians eligible for both programs. There are roughly 1.1 million duals in California. State health officials hope that consolidating the funding and services from the two agencies will allow the state to deliver better, more integrated care at a lower cost.

About 3,200 of San Mateo County’s 10,000 dual eligibles were passively enrolled last week, according to DHCS officials.

State officials predict about 120,000 duals will participate in the three counties that start the program on May 1.

Los Angeles County has an estimated 374,000 dual-eligibles. CMS officials set that county’s cap at 200,000 for this project.

“This will help more Californians with complex health care needs remain in their homes and communities and have a higher quality of life,” said Toby Douglas, director of DHCS, in a written statement.

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