LA Care Passes Duals Readiness Review

Federal officials yesterday cleared LA Care Health Plan for takeoff in the state’s duals demonstration project.

By passing its readiness review, the largest publicly operated health plan in the state will be able to accept enrollees when the duals project is launched in Los Angeles County in July.

LA Care still will not be allowed to participate in passive enrollment until around January 2015 because of low CMS star ratings. So it won’t be able to automatically enroll people who are dually eligible for Medi-Cal and Medicare benefits, but it will be able to enroll those duals who choose the LA Care plan — and that is just fine with Howard Kahn, the CEO of LA Care. 

“We have the green light. This is CMS saying we can begin the marketing process to start enrolling people within the duals project,” Kahn said. “The nice thing is, the people we’ll get will be choosing LA Care.”

State officials hope to enroll 200,000 people in Los Angeles County, which is a little less than half of the estimated 374,000 dual-eligibles who live there. CMS officials set the county cap at 200,000 for the project.

Passive enrollment — a process in which beneficiaries are automatically moved into managed care plans — is scheduled to start July 1 in Los Angeles County, which means LA Care will miss out on six months’ worth of passive enrollees in the project. Since passive enrollment happens by birthdate, LA Care would be missing out on about half the passive-enrollment pool. But Kahn said that’s not a big concern.

“Realistically, I don’t see the cap as a limitation,” Kahn said. “There will be enough opt-outs that I don’t see the cap as an impediment. There are many things I might lose sleep over, that’s not one of them. It’s not a worry.”

Getting big numbers of enrollees isn’t the point for LA Care, Kahn said. “We’re interested in participating in good pilots and a good project,” he said.

“We think the greatest opportunity is with the choice people.”

Kahn expects a lot of people to choose the LA Care health plan.

“The important thing here is not to lose sight of why we’re doing this in the first place,” Kahn said. “In Los Angeles County, for this population, care is not coordinated. We are not maximizing the benefits for these individuals right now. This is an opportunity to fix that. Just like Obamacare, there will be bumps, but it’s the right direction.”

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