State Wins Duals Project Court Ruling, Medicaid Defense Fund Plans to Appeal

A California Superior Court judge’s decision Friday that the state may continue its demonstration project for dual eligibles could affect up to 456,000 Californians who are eligible for both Medicare and Medi-Cal — roughly half of the state’s 1.1 million duals. The duals in certain counties are part of the state’s Cal MediConnect pilot plan to move them into Medi-Cal managed care plans.

Meanwhile state officials announced Friday it will delay entry of two counties into the eight-county duals demonstration project till at least July 2015.

Sacramento Superior Court Judge Shelleyanne Chang “in essence denied all relief to duals in this case,” said Lynn Carman, attorney for the Medicaid Defense Fund, a group of consumer advocates and independent living centers who filed the lawsuit challenging the project. The group plans to appeal.

“It is Medicaid Defense Fund’s intention to seek state appeal court relief as rapidly as possible,” Carman said. 

“Judge Chang’s decision is … contrary to law and the evidence,” Carman said in an email, “and will devastate half a million duals who will lose their chosen Medicare doctors, hospitals and medicines, on account of her erroneous decision and refusal to act.”

In a separate action, the state decided to delay Alameda and Orange counties from the duals project till July 2015.

The project has also been delayed in Orange County. CMS officials found network adequacy problems with the county’s only participating health plan in — CalOptima — and Orange County’s participation was delayed until at least January 2015.

“Cal MediConnect will not move forward in Orange County until CalOptima demonstrates that it has corrected these issues as required by CMS and the state,” said Norman Williams, deputy director of public affairs for the Department of Health Care Services, in an email.

“Until CMS and DHCS are confident in Cal Optima’s readiness, enrollment will be postponed,” Williams said. “DHCS is actively working with CalOptima to address the issues the plan has identified as barriers to readiness.”

Alameda County was delayed because of the state takeover in May of the finances of the Alameda Alliance for Health, a local initiative public health plan in Alameda County. The Department of Managed Health Care was concerned about non-payment of claims by the Alliance, and appointed a conservator to temporarily manage the plan.

“The Alameda Alliance has issues with its financial reserves and is in conservatorship, so DHCS determined a delay was needed,” Williams said. “DHCS and the Department of Managed Health Care are actively working with Alameda Alliance to address the issues the plan has identified as barriers to readiness.”

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