Due to advocacy on the part of the California Medical Association (CMA) and other stakeholders, the plan to shift Medicare/Medi-Cal “dual eligibles” into a managed care plan has been delayed by several months.
Under a pilot project approved by the Legislature in 2010, dual eligibles – those who meet eligibility requirements for both the Medicare and Medi-Cal programs – in Los Angeles, Orange, San Diego and San Mateo counties will be passively enrolled into a managed care plan. This means that if dual eligibles wish to remain in fee-for-service Medicare, they will have to actively choose to do so.
The plan was previously scheduled to begin on October 1, 2012, but due in large part to CMA’s advocacy efforts it will now begin in early 2013, according to a plan submitted to the Centers for Medicare & Medicaid Services (CMS) by the state last week. The effective date of the enrollment will be no earlier than March 1, 2013, and not later than June 1.
CMA had expressed serious concern that, with the very tight timeline originally proposed by the state, there would not be adequate time for patients and physicians to learn about the proposed changes. Physicians will now have the rest of 2012 to educate their patients about enrolling in a plan or exercising their right to opt out of the program.
The plan submitted to CMS also exempts end-stage renal disease (ESRD) patients completely from the program. This too, was based on concerns raised by CMA and others about the potential disruptions to dialysis treatment that could be caused by the transition to managed care.
While CMA continues to oppose the dual eligibles pilot project, these two steps are improvements that will make the plan more workable for physicians if any part of it moves forward.
Now that the duals plan has been submitted to CMS, CMA will be submitting comments to the federal government asking them to limit the size and scope of the projects, and to ensure that key physician and patient protections are included.
In his 2012 budget, Governor Jerry Brown proposed expanding the four county pilot project statewide. CMA has been active in trying to stop this expansion. Physicians are encouraged to access CMA’s new online dual eligibles resource center, www.cal.md/duals, for up-to-the-minute information about the dual eligibles projects and to learn about how you can help to stop the expansion.
Contact: David Ford, (916) 551-2554 or firstname.lastname@example.org.