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State Laying Foundation for Duals Conversion

The state’s Department of Health Care Services released a series of draft papers this week, outlining some of the concerns and aims of its planned conversion program, which will eventually offer managed care choices to dual eligibles — those Californians who are eligible to receive both Medi-Cal and Medicare benefits.

The latest paper, released yesterday and expected to be posted on the DHCS website today, looks at the possible scope of that transition and finds it could include many more than the 150,000 people originally estimated for the conversion program.

“There are 370,000 duals in Los Angeles County alone,” according to Peter Harbage of Harbage Consulting, who worked on the papers. “There are another 250,000 in the next four largest counties. The paper opens the conversation on that point, as well as on other key issues.”

The three draft papers released earlier this week are designed to frame the overall discussion of the conversion effort.

“The goal of all of these papers is to facilitate a stakeholder process,” Harbage said, “to see what’s possible in a demonstration project.”

The state hopes to involve as many voices as possible in shaping this project, according to Harbage. “The level of involvement from outside folks is critical because this is such a fragile population,” he said. “Trying to make that transition happen is a real challenge, so you have to make sure you’re considering all opinions and concerns.”

This dual-eligible conversion program is separate from the transition plan to eliminate adult day health care as a Medi-Cal benefit, though about 26,000 duals have been offered the chance to join a managed care plan. The ADHC effort is happening before the Dec. 1 elimination deadline, and about 14,000 of those ADHC patients have opted out of the managed care conversion so far.

This dual-eligible demonstration project has a broader scope and a much longer time frame, with a launch planned for the end of 2012. And to work out the details of the conversion for that many people will be complicated, Harbage said.

“It’s a significant set of issues, and it’s an ambitious time frame, to have it up and running by the end of next year,” Harbage said. “That’s doable, but there is a lot to discuss. Our hope is that these papers will help focus the ongoing conversation.”

The three papers cover long-term care coordination, behavioral health issues and consumer protections.

“We wanted to start with a broad approach, so you have a good foundation for the conversation,” Harbage said. “It’s not that detailed yet, but this is how we’re going to get to the detail.”

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Capitol Desk Medi-Cal Medicare