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California Gains Federal Approval for Duals Demonstration

Today, California received federal approval for a three-year demonstration program, nearly two years in the making, to improve care for the Californians with both Medi-Cal and Medicare coverage (dual eligibles).  The Duals Demonstration, now titled Cal MediConnect is scheduled to begin no sooner than October 2013.

Dual eligibles account for nearly 25% of California’s Medi-Cal costs. Cal MediConnect will test innovative payment and service delivery methods to improve coordination, enhance quality of services, promote independence in the community, assist beneficiaries in receiving timely care, and reduce state and federal costs. Participating health plans and DHCS will negotiate capitated payments covering all required services, which include the primary care provider, In Home Supportive Services (IHSS) provider, behavioral health specialist, family and/or community supports, and other providers as appropriate.

Released March 27, 2013, the MOU between CMS and DHCS details procedures to implement and operate Cal MediConnect. A plan readiness assessment is required prior to executing a three-way contract with selected health plans. Residents of Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara counties will be eligible for Cal MediConnect.

The MOU offers several significant changes from the original application DHCS submitted last year. The changes are listed below:

  • Cal MediConnect will be implemented so sooner than October 2013, pursuant to health plan readiness. The first informational notice will be sent to beneficiaries no earlier than July 2013.
  • Participating counties will no longer phase in enrollment over a 12-month period. The MOU lays out enrollment strategies for each county, with San Mateo completing enrollment in January 2014 and Los Angeles enrollment occurring over a 15-month period.
  • The MOU offers beneficiaries enrolled into the demonstration the option to opt out at any time. There will NOT be a 6-month holding period.
  • Home and Community-Based Waivers will remain open.
  • The total size of the demonstration population has been halved to 456,000 eligible.
  • A cap of 200,000 participants has been set for Los Angeles County. The original proposal did not have any participant caps.

 

“This federal approval marks a significant milestone for improving how California delivers health care to some of our most vulnerable Californians.”

-Diana Dooley

                                                           California Health and Human Services Secretary

More information on Cal MediConnect can be found here.

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