Please check back regularly, as information will be updated as it becomes available.
The 2012 budget authorized the Coordinated Care Initiative (CCI), which would allow persons eligible for both Medicare and Medi-Cal (dual eligibles) to receive medical, behavioral, long-term supports and services (LTSS) and home-and community-based services coordinated through a single health plan in eight counties (Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara). CCI contains two main components (1) Cal MediConnect-transitioning individuals who are eligible for both Medi-Cal and Medicare (duals) away from fee for service and into managed care and (2) Integration of long term supports and services (LTSS) into managed care. No more than 456,000 individuals would be allowed to enroll into Cal MediConnect.
The Governor recently signed legislation that would set forth certain circumstances that would render components of CCI inoperable. Of note are the following provisions:
- Delinking provision. This change states that if for any reason the demonstration cannot move forward, the state has the authority to “delink” enrollment of dual eligibles into Medi-Cal managed care from LTSS. This would allow mandatory enrollment of dual eligibles into Medi-Cal managed care and keep LTSS as is, even if the demonstration does not go forward.
- Dual Special Needs Plans (D-SNP) provision. D-SNPs are a kind of Medicare Advantage plan and are administered by both local health initiatives and private health systems. Individuals qualify for a D-SNP if they are in Medicare Advantage, have a special need, and are eligible for Medicaid. As with all Medicare Advantage plans, participation in D-SNPs is voluntary, although some plans are allowed to passively enroll their members. There are currently 32 D-SNPs in California that enroll nearly 160,000 dual eligibles. This new legislative provision exempts recipients enrolled in a D-SNP plan operating in a CCI county to be passively enrolled into Cal MediConnect; indicating a slower mandatory conversion for dual eligibles into the demonstration. In 2015, D-SNPs can be passively enrolled into Cal Mediconnect.
- Stakeholder provisions. This provision requires DHCS beginning in August 2013, to convene stakeholders who would meet quarterly to review the progress on the CCI and make recommendations to the Legislature for the duration of the demonstration. The legislation does not specify physicians be part of the stakeholder process, but more broadly includes “representatives from primary care providers and specialists.”
- Poison pill language. This change states that if the Department of Finance does not find there are adequate savings for the CCI, the demonstration will be terminated.
While DHCS continues to maintain that the duals project is moving forward and will (potentially) begin enrollment in April, the provisions adopted by the legislature suggest potential alternative approaches should the full program not be implemented.
CMA has established this resource center to help physicians and their patients understand what is being implemented. Here you will find:
- Basic information about what is being implemented
- Eligibility, enrollment and opt-out information
- Continuity of care provisions
- Financing and payment information
- Patient letters
For more information, please click here. Updated 3/25/14