Cal MediConnect Program

The Department of Health Care Services (DHCS) and the federal Centers for Medicare and Medicaid Services (CMS) announced March 27, 2013 a signed Duals Demonstration Memorandum of Understanding (MOU) to integrate care for dual eligible beneficiaries as a component of California’s Coordinate Care Initiative (CCI).
The MOU signifies federal approval and also serves as the framework for moving forward with the demonstration that builds on more than two years of effort by committed stakeholders.
This major leap forward to better integrate California’s fragmented service delivery systems from now on will be called the Cal MediConnect program.
Through Cal MediConnect, eligible beneficiaries will have the opportunity to combine all their Medicare and Medi-Cal benefits into one health plan — and receive more coordinated and accountable care. Enrollment is expected to begin no earlier than October 2013.
The MOU reflects the commitment of CMS and DHCS to providing high quality, integrated care to beneficiaries eligible for both Medicaid and Medicare. DHCS appreciates the feedback received over the last two years from advocates, physicians, beneficiaries and other stakeholders.

The MOU contains several changes from the state’s original proposal:
•Timeline: Enrollment in Cal MediConnect will begin no earlier than October 2013. Beneficiaries would begin receiving notices about their choices and upcoming changes no earlier than July 2013. Previously, the 2012 Budget Act (released in January 2012) assumed the enrollment process in all counties would phase in over a 12-month period beginning in March 2013.
•Enrollment Strategies: The MOU describes the enrollment strategy for each of the eight counties where the Cal MediConnect program will be implemented: Alameda, Los Angeles, San Bernardino, San Diego, San Mateo, Santa Clara, Orange and Riverside. Specifically, assuming an October 2013 start, San Mateo County enrollment will be completed in January 2014 and Los Angeles County enrollment will happen over 15 months.
•Stable Enrollment Period: Beneficiaries who enroll in a Cal MediConnect health plan can opt out at anytime; there will be no stable enrollment period. California originally proposed an initial six-month stable enrollment period, during which eligible beneficiaries would have remained in the same health plan.

•Home and Community Based Service (HCBS) Waivers: California’s HCBS waivers will now remain open. This is a change from the original proposal that called for closing them.
•Size of the Demonstration:The MOU allows for 456,000 total beneficiaries to be eligible for enrollment into the Cal MediConnect program. This is almost half the size called for in the Governor’s 2012-2013 budget (released in January 2012).
•Number of Participants in Los Angeles County: The MOU caps the number of beneficiaries who may enroll in Los Angeles County at no more than 200,000. The earlier proposal had no such cap.

Next steps in implementing the Cal MediConnect program include conducting readiness reviews of the selected health plans; finalizing capitation rates, executing three-way contracts between the health plans, CMS and DHCS, pending results of the readiness review; and continuing to develop the operational systems needed for activities like enrollment, monitoring, and evaluation.

Posted on: May 21st, 2013 at 9:26pm by howardhwang. Filed under: Customer News Letter
Tags:

Get a Quote or call for a quote at 800-646-8100