Ironing Out Details of Duals Conversion

State officials met with stakeholders in Sacramento yesterday to answer questions and work out the final details of the duals demonstration project — an ambitious plan to enroll an estimated 700,000 dual-eligible Californians in 10 counties into Medi-Cal managed care.

Enrollment will be mandatory for beneficiaries eligible for both Medi-Cal and Medicare. Jane Ogle, deputy director of health care delivery systems at the Department of Health Care Services, was quick to point out that beneficiaries would keep their own physician, even if that physician is not in the Medi-Cal network, and that beneficiaries have the power to opt out of the demonstration project, if they want.

“There is no need to assign a new doctor to people,” Ogle said. “There just is no need to do that.”

DHCS plans to release the names of the 10 counties it selects for the Coordinated Care Initiative on Wednesday, Ogle said.

“We have expanded the demonstration project from four counties to as many as 10 counties, starting in January 2013,” Ogle said. “Then it will expand to other managed care counties the year after that, and hopefully to expand to rural non-managed care counties [and all California counties] by 2015.”

The DHCS effort over the last year to move seniors and persons with disabilities into Medi-Cal managed care plans has had mixed results.Ogle said the state learned from that experience and plans to launch seven specialized work groups to address some of the concerns people had with the SPD conversion in an effort to make this conversion go more smoothly.

That includes a more targeted and aggressive beneficiary outreach plan, Ogle said. “We have to do a lot more provider outreach, so they understand what’s happening. That was one of the big things that didn’t happen before, is the providers didn’t know exactly what was happening.”

Abbie Toten of the California Association of Health Plans said better data matching would help, too.

All of that outreach and coordination takes time, according to Deborah Doctor of Disability Rights California.

“You’re talking about different materials, different outreach strategies, better notifications, better data matching, and all of these other things you want to do differently,” Doctor said. “The beneficiaries are going to be notified in October. And here we are almost at the start of April. All of that leads our organization to think that this is moving way too fast.”

That’s why DHCS wants to get started immediately, Ogle said, now that the final trailer bill language has been finalized. “We will be working aggressively in April and May and June to address these things,” Ogle said.

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Capitol Desk Medi-Cal Medicare