State Alters Rollout of Duals Project

State health officials yesterday announced several changes to the April 1 launch of the duals demonstration project in California.

The pilot program to coordinate care for the estimated one million Californians dually eligible for Medicare and Medi-Cal benefits will initially target roughly 400,000 people in seven counties. The first step is to automatically move dual eligibles into managed care plans — a process known as passive enrollment.

An eighth county, Orange County, was part of the original rollout plans but CMS officials recently deemed the CalOptima health plan was not prepared to handle the Medicare side of the transition and it will likely be excluded from the duals project until at least January, 2015, state officials said. CalOptima was the only insurer lined up for the duals pilot in Orange County.

CMS also found fault with LA Care, one of two health plans participating in the duals project in Los Angeles. LA Care is not prohibited from participation but federal officials will not allow it to passively enroll beneficiaries until January, 2015.

That restriction prompted one of yesterday’s announced changes, which included:  

  • Three Los Angeles-area health plans were added to enroll people in Cal MediConnect. That takes up the slack from the inability of LA Care to passively enroll duals until 2015, though LA Care will continue to enroll people who choose to join that plan. Three new health plans join HealthNet as insurers in the duals project in Los Angeles County — CareMore, Care 1st and Molina Healthcare.
  • In L.A. County, passive enrollment will start no sooner than July 2014.
  • In three other counties, due to 60-day notices going out later than expected, enrollment in April will be strictly voluntary. And passive enrollment in those areas — Riverside, San Bernardino and San Diego counties — won’t start until May 1 at the earliest.

“We want to make sure we get it right,” said Jane Ogle, deputy director at the Department of Health Care Services. “We have the state of California and the federal government working together [on a big project], and it’s going to take time to get it right. Some of the 60-day notices were delayed in three counties.”

There have been some issues in other counties, as well. In Alameda County passive enrollment will be delayed because of financial issues, and passive enrollment in Santa Clara County is delayed by technical glitches.

That leaves a single county — San Mateo County — that will begin passive enrollment as originally planned starting Apr. 1.

The Department of Health Care Services scheduled a stakeholder conference call today to discuss the changes.

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Capitol Desk Medi-Cal Medicare