State Wins Duals Project Court Ruling, Medicaid Defense Fund Plans to Appeal


On Friday, August 1, a California Superior Court ruled that the state may continue its demonstration project for dual eligibles.

The program begins with a three-year demonstration project that will see a large portion of the state's Medicare/Medi-Cal dual eligible beneficiaries transition to managed care plans. The project will impact approximately 456,000 dual eligible beneficiaries in eight counties – Alameda, Los Angeles, Orange, Riverside, San Diego, San Mateo, San Bernardino, and Santa Clara.

The lawsuit alleged that Cal MediConnect is not legally authorized because DHCS failed to obtain timely federal approval of the demonstration project as required under the state law establishing the project. Second, the lawsuit alleged that there are deep flaws with the implementation of the project thus far, including problems with the notices to beneficiaries and the enrollment form. Specifically, the lawsuit alleged the notices were not written at a 6th grade reading level as required by law and in addition, the enrollment form is too confusing to meaningfully provide an opt out choice for beneficiaries.

Meanwhile state officials announced Friday it will delay entry of Alameda and Orange counties into the eight-county duals demonstration project till at least July 2015. 

(Source: David Gorn, 8/4/2014)