Legislators Question Duals Program Implementation at Oversight Hearing

State legislators yesterday expressed concerns about the state’s readiness for an April 1 rollout of the duals demonstration program, the central component of the Coordinated Care Initiative.

During a joint hearing of the Senate Committee on Health and the Senate Committee on Budget and Fiscal Review, legislators asked pointed questions of state health officials managing the program.

“This is a complex and ambitious task,” said Sen. Mark Leno (D-San Francisco), the hearing co-chair. “We want to know what needs to be done, and how to make sure that, first and foremost, we do everything we possibly can to make this transition as smooth as possible.”

Leno referred to previous state transitions of seniors and persons with disabilities to managed care plans and said he didn’t want rocky results this time around.

“I think we all have to admit there have been … bumps in the road,” Leno said.

Toby Douglas, director of the Department of Health Care Services, testified that the state is ready and able to handle the current transition of roughly 400,000 Californians dually eligible for Medicare and Medi-Cal into managed care plans.

“We do want to stress, we never said it was easy to do this,” Douglas said.

The project has been in the planning process for three years, Douglas pointed out. That should be enough time to get stakeholders’ input, refine the state’s plans and get the program started, Douglas said.  

“For over 50 years, we have made the situation more challenging [for this frail population], and more difficult for them to manage,” Douglas said. “This is [currently] a complicated system, and it jeopardizes their quality of life and wastes money.”

Concerns have been heightened by federal CMS restrictions on health plans in two of the eight counties in the duals demonstration. LA Care cannot take on any automatically assigned enrollees and in Orange County CMS put a halt to any enrollment in CalOptima, the county’s only participating health plan. Orange County has about 57,000 duals, making it the second-largest county in the duals program.

Without Orange County’s duals, the state now will initially target 399,000 Californians in seven counties as potential enrollees in managed care plans.

DHCS officials said, in light of the CMS Medicare findings, the state will conduct its own audit on the Medi-Cal side, starting next week. Douglas said he expects results from that audit in a month or two. 

In addition to those problems, Alameda County has had some financial issues, and Santa Clara some technical problems, delaying those programs. In three other counties (Riverside, San Bernardino and San Diego), the six-month notices were delayed, so those counties can’t start passive enrollment until May.

“Initially we saw great hope in this program,” said Sen. Jim Nielsen (R-Gerber). “We still do hope this can take us where we’d like to go.”

Leno and Sen. Ed Hernandez (D-West Covina) asked if DHCS officials had considered slowing down the transition, or delaying implementation in certain counties — particularly Los Angeles County, which has the largest duals population of any county in the state.

“To me, what’s the most important is to make sure there is little to no disruption in care, particularly in this segment of the population that we need to protect,” Hernandez said.

“We do have the ability to slow down or even stop enrollment,” Douglas said.

Douglas’ responses did not seem to satisfy Leno.

“I think this is lacking in some detail that I know needs some answering,” Leno said.

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Capitol Desk Medi-Cal Medicare