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Main Push in Duals Project Starts, L.A. County Launches Passive Enrollment

On Thursday, California health officials launched the biggest phase of the Cal MediConnect duals demonstration project by beginning passive enrollment of dual eligibles in Los Angeles County.

The duals demonstration project, also known as Cal MediConnect, is part of the state’s Coordinated Care Initiative.

In a written statement, Department of Health Care Services officials, said, “The Coordinated Care Initiative is [a] tremendous opportunity to improve care and care coordination for dual-eligible beneficiaries in California,” adding, “For too long, this population has had to navigate a fragmented system to receive the health care and social services they need. Under the CCI and Cal MediConnect, we are realigning incentives in the system to get beneficiaries the care and support 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.”

Cal MediConnect plans to integrate Medicare and Medi-Cal — California’s Medicaid program — services and funding for Californians eligible for both programs. State health officials hope that, by consolidating the funding and services from the two agencies, individuals can receive better, more integrated care at a lower cost to the state.

According to DHCS, 26,759 duals were enrolled Thursday and now are eligible to receive managed care services in Los Angeles County. The total for new enrollment hit 32,120 in the five participating counties, and the total enrollment through Cal MediConnect now stands at 49,966 dual eligibles.

The state wants to move as many as 456,000 Californians in eight counties who are dually eligible for Medi-Cal and Medicare into Medi-Cal managed care plans. Five counties have started enrolling duals so far. Federal CMS officials have set a 200,000-person ceiling for Los Angeles County enrollment during the project.

Los Angeles County has the highest number of duals in the state, with roughly 374,000 of the 1.1 million duals statewide.

Los Angeles is the fifth county to start its passive enrollment effort — where dual eligibles will be sent a choice form by mail and will be automatically enrolled in a managed care plan if they do not respond.

Three counties — Alameda, Orange and Santa Clara — won’t start enrollment efforts until January 2015 at the earliest. Four other counties — Riverside, San Bernardino, San Diego and San Mateo — started passive enrollment a couple of months ago (one of them in April and three of them in May).

Those earlier enrollment efforts were fraught with problems, according to Amber Cutler, staff attorney in Los Angeles for the National Senior Citizens Law Center. Cutler said whatever issues were brought to light in the past few months will be amplified by the sheer numbers of Los Angeles County’s dual eligibles.

“From our experience in other counties, when people go into a pharmacy or go into a doctor’s appointment, they’re going to realize for the first time they have a new plan,” Cutler said.

“A few days from now, when people find out they don’t have the same Part D [pharmaceutical] coverage or they can’t see their doctor,” she said, “the health plans are going to get a flood of calls, and the ombudsman is going get a flood of calls.”

The bottleneck, Cutler said, likely will be the ombudsman, who can help people dis-enroll from their new managed care plan.

“What’s going to happen is the ombudsman is going to get slammed,” Cutler said.

The NSCLC recently came out with a list of 27 things to fix in the duals demonstration project. A spokesman for DHCS said the department is working or has resolved most of the items on that list.

Cutler is not so sure.

“Just in July, there are suddenly 26,000 duals to deal with, and in August there’s another 14,000 enrolled. There is no time for anyone to catch their breath. There is no time for plans to do what they’re supposed to do,” in terms of coordination and integration of care for this complicated, multiple-chronic-condition population, she said.

“All the organizations [that] are helping these people are bracing themselves,” Cutler said. “There are so many people who don’t have any clue this is happening to them, and we’re fearful of what’s about to happen.”

In response to the many concerns voiced by stakeholders, DHCS in a written statement said:

“We are working closely with the Cal MediConnect plans, providers, stakeholders and beneficiaries to ensure that the program lives up to this potential. No transition is without its challenges, but we are committed to transparently addressing any issues as they arise. As beneficiaries are joining Cal MediConnect, they will begin to see the benefits of care coordination, as they work with their interdisciplinary care teams to develop and execute personalized care plans. We will be continuing to monitor implementation in Los Angeles County very closely, but we are confident that the Cal MediConnect plans are ready to help support this population.”

The start of passive enrollment in the Los Angeles duals project does not include one of the larger providers in the county — LA Care will not passively enroll dual eligibles until January 2015.

LA Care had a quality rating that dipped below CMS standards and it won’t be able to automatically enroll anyone till January. LA Care did pass its CMS readiness review, so it still can voluntarily enroll duals until then.

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Capitol Desk Medi-Cal Medicare