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Duals Project Schedule Unchanged

Californians in three counties eligible for Medicare and Medi-Cal will soon start to receive 60-day notices in the mail moving them into managed care plans as part of the state’s Coordinated Care Initiative.

A coalition of advocacy groups for seniors and the disabled asked federal and state officials to temporary halt California’s duals demonstration project in seven of the eight pilot counties.

So far, state officials have not responded to that request and the project remains on schedule.

The state’s duals demonstration project aims to coordinate care and financing of care for the estimated 1.1 million Californians eligible for Medicare and Medi-Cal. The plan calls for the state to automatically enroll almost half of them — about 456,000 — in managed care plans over the next few months. Unless beneficiaries specifically opt out, they will be moved into the program in a process known as passive enrollment.

Notices are due to go out this week to roughly 92,000 dual-eligibles in Riverside, San Bernardino and San Diego counties. Passive enrollment in those counties is set to begin May 1.

The 60-day notices will include a “choice form” from the Department of Health Care Services. One of the choices will be to opt out of the duals demonstration project and remain in fee-for-service Medi-Cal.

The May 1 launch of passive enrollment in those three counties comes one month later than originally planned. Only one county, San Mateo, will start passive enrollment by the original target date of April 1.

Other counties in the demonstration project have different timelines for different reasons.

Orange and Santa Clara counties aren’t expected to start till Jan. 1, 2015. Santa Clara County is facing technical issues and the one participating health plan in Orange County did not pass the federal CMS readiness review. CalOptima hopes to correct problems uncovered by federal officials in time for 2015 enrollment. Meanwhile, state officials are starting their own investigation of CalOptima on the Medi-Cal side.

Los Angeles and Alameda counties won’t start passive enrollment until July. One of the two health plans in Los Angeles, LA Care, had low star ratings from CMS and won’t be able to start passive enrollment till January 2015. LA Care will be able to enroll anyone who chooses LA Care on the choice form.

The 60-day notices will be staggered, based on beneficiaries’ enrollment dates, according to Norman Williams, deputy director of public affairs at DHCS.

“Beneficiaries currently in Medi-Cal managed care will all enroll in the same month when passive enrollment begins in their county,” Williams said in a written release. “However, beneficiaries who are currently in Medi-Cal fee-for-service will enroll on the first day of their birth month. The 90-, 60- and 30-day notices will continue to be mailed on a rolling basis once passive enrollment has begun.”

The request for a delay came from six organizations: 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.

Related Topics

Capitol Desk Medi-Cal Medicare