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Judge Delays Duals Injunction Decision

A California Superior Court hearing last week in Sacramento — to determine whether or not to issue an injunction to stop the state’s duals demonstration project — came to a quick end, before it even really started.

“I don’t feel entirely comfortable issuing a ruling today,” said Superior Court judge Shelleyanne Chang at the opening of the July 10 hearing. “I know this is an important issue and, quite frankly, I can’t say I’ve read every page of this testimony, and I want to give it the attention it deserves.”

A new hearing for the lawsuit — and likely a decision on an injunction — has been set for Aug. 1.

There was a lot of written testimony, and some of it was given to the judge an hour before the hearing, according to Rocky Delgadillo, CEO of the Los Angeles County Medical Association, one of the litigants in the lawsuit.

“We have a very thoughtful judge who wants to render a thoughtful decision,” Delgadillo said. “So we look forward to Aug. 1 and hope the court will see our side of things.”

The lawsuit was brought by the LACMA and several independent living centers, and Delgadillo said they’re trying to protect the vulnerable dual-eligible population (those eligible for benefits under both Medicare and Medi-Cal, the state’s Medicaid program).

The state’s duals demonstration project, known as Cal MediConnect, hopes to move about 456,000 of the state’s 1.1 million duals into Medi-Cal managed care programs. It has started passive enrollment of those duals in five of the eight demonstration counties. Passive enrollment means if dual-eligibles don’t choose to opt out of Cal MediConnect, then they’re passively or automatically enrolled in managed care plans.

Many dual-eligible patients have cognitive impairments such as dementia or Alzheimer’s disease, and many are not English-proficient, Delgadillo said. As a result, a good number of duals won’t know they’re enrolled in another plan until they go to their doctor and find out that’s not their doctor anymore, he said.

“This is a serious issue, a very serious issue,” Delgadillo said. “We believe it’s an ill-conceived, ill-designed bureaucratic takeover of the lives of the most vulnerable population in California.”

And, he said, calling it a pilot program is a misnomer, because it aims to enroll almost half of the duals in the state.

“This is a big, big program. It’s not a pilot,” he said. “This is a major dislocation of people … and we are going to do all we can to protect these patients.”

Officials at the Department of Health Care Services, which is overseeing the Cal MediConnect transition, have a policy of not commenting on pending litigation.

However, Norman Williams, deputy director of public affairs for DHCS, did say that the duals project has been carefully planned over many years, with constant input and alteration from stakeholders in the duals community.

“Cal MediConnect is a key part of the Coordinated Care Initiative, which is a tremendous opportunity to improve care and care coordination for dual-eligible beneficiaries in California,” Williams said in an email. “The current system of care is very fragmented for these individuals. They must navigate multiple systems to access the care and services they need.”

Fixing that problem has been a big goal for health officials, and the enrollment process for the duals project has been an important part of that, he said.

“California has gone through a three-year development and design process for the Cal MediConnect program, which has been marked by our commitment to stakeholder input,” Williams said. “Under the CCI and Cal MediConnect, we are realigning incentives in the system to get beneficiaries the care and supports they need, when and where they need it. The result will be that more older Californians and more Californians living with disabilities will receive higher quality care and have the support they need to live at home and in the community.”

At the heart of advocates’ concern is the form being used to enroll dual-eligibles in a managed care plan. The “choice form” is fatally flawed, according to Lynn Carman, attorney for the advocates, because there is no clear choice to stay out of the Cal MediConnect program and managed care, he said.

“The so-called choice form has no place on it to choose to opt out … for Medicare services,” Carman said. “It only gives the dual a choice of managed care plans.” That opt-out choice is statutorily required, Carman said, and the dual-eligibles in the demonstration project are prevented from opting out by the DHCS notices.

“DHCS is despicably and unlawfully trapping hundreds of thousands of duals into … plans for Medicare services, contrary to the free-choice provisions of [law],” Carman said.

Related Topics

Capitol Desk Medi-Cal Medicare