If Duals Project Is Curtailed, Future Is Cloudy for Program for Frail Seniors

Some advocates and legislators are urging the state to extend the timeline for transitioning the Multipurpose Senior Services Program into managed care plans within the seven-county duals demonstration project.

The duals project, also known as Cal MediConnect, is part of the Coordinated Care Initiative that affects roughly two-thirds of the state’s duals population in seven counties — Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo and Santa Clara.

The duals are a frail, elderly and disabled population of Californians dually eligible for Medicare and Medi-Cal coverage.

MSSP is a federal waiver program for some of the frailest Californians, to help them remain at home and keep them out of institutions such as nursing homes. The program would remain the same in MSSP sites outside of the seven-county demonstration project.

The complicated set-up of programs within programs gets more complex with the possible elimination in January 2016 of the CCI pilot project. That project needs to be cost-effective to continue, and in part because of a higher-than-expected opt-out rate, it may not be. In the governor’s proposed fiscal year 2015-2016 budget, the CCI still is listed as cost-effective but that’s primarily because the scales are weighted by a managed care organization tax. Without that tax money, the CCI would show a cost, rather than savings. If those numbers don’t improve by January 2016, the CCI would end operations.

That’s one reason why advocates lined up at a March 9 budget subcommittee hearing to ask the state to consider a longer timeline for the transition — 36 months, rather than the current 19 months.

“Before CCI, we were a quiet little group of nurses for 30 years,” said Denise Likar, past president of the MSSP Site Association. “We’ve been successfully helping them stay at home, prevent avoidable trips to the [emergency department] and the hospital and keep them out of nursing homes.”

Likar said the usual approach, especially when transitioning such a frail group to managed care plans, is to set up the basics and then begin the working phases, then getting data and refining delivery of care, to make sure people actually are getting the care they need on one end before eliminating it on the other end. She said that, half a year into the transition, the health plans and MSSP sites are “still dealing with basic startup issues,” such as enrollment and payment structure, and haven’t even begun the work of coordinating care.

“We’re getting very concerned,” Likar said. “Because as the time clock ticks and pressures mount on the state, and on the sites and on the health plans, we have to start making that transition in a few months, and with no data. We also know … there’s a lot of work that needs to be done to create that model of care. So far the work hasn’t commenced. We don’t think the work can be done safely, in a timely period.”

Likar added that she and others working with MSSP beneficiaries all see the vision of moving the population into a more coordinated system of care, but she said, “Rushing on this population isn’t going to yield a good outcome.”

If CCI is curtailed in January 2016, she said, that would mean the 19-month time clock would expire before the demonstration project comes to fruition.

“That seems a little out of synch to us,” she said.

Mari Cantwell, chief deputy director at the Department of Health Care Services, which oversees Medi-Cal and the CCI duals project, said it’s “premature” to extend the timeline.

“We remain committed to the program and making sure the reason people are enrolling is that the care they’re receiving is better than what they’d be receiving without this program,” Cantwell said.

Cantwell did not dismiss the notion outright, though.

“At some point we could consider that,” Cantwell said. “We are open to continue that conversation, but at this point in time, I think it’s a little premature.”

Assembly member Tony Thurmond (D-Richmond), chair of the Assembly Budget Subcommittee on Health and Human Services, urged Cantwell and other state officials to strongly consider it.

“Many advocates have asked for more time, to make sure the quality of care not be sacrificed in what seems like a tight timeline,” Thurmond said.

“We hope you consider that and come back to us at a later date,” he said. “It seems like a reasonable request to have more time.”

Related Topics

Capitol Desk Medi-Cal Medicare