DHCS Delays Duals Pilot Project Until April 2014

The California Department of Health Care Services (DHCS) has announced that it would delay by three months implementation of the state’s “pilot project” to redesign care for Medicare/Medi-Cal dual eligibles. The program, called CalMediConnect, is now expected to begin no earlier than April 2014.

Authorized by the Assembly in July 2012, the project is an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities. The program begins with a three-year demonstration project that would see a large portion of the state’s dual eligible beneficiaries transition to managed care plans. The project will impact approximately 450,000 duals in eight counties – Alameda, Los Angeles, Orange, Riverside, San Diego, San Mateo, San Bernardino, and Santa Clara.

Patients will be enrolled in a managed care plan unless they actively opt out.

CPMA joined CMA in urging DHCS to withdraw the overly-ambitious project proposal and to take more time to develop a scaled-down project that gives seniors and the professionals that take care of them information and feedback mechanisms to assure continuity of care and improved care coordination. Unfortunately, the Centers for Medicare and Medicaid Services (CMS) approved the project, clearing the way for the state to begin implementation.

CPMA will work with DHCS and other stakeholders to minimize the impact of the transition on members and their patients. CPMA has also developed a Duals Resource Center to help members and their patients understand what is being implemented.

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