Medi-Cal Experiment is Failing Most Vulnerable Patients

Medi-Cal Experiment is Failing Most Vulnerable Patients

 

The Affordable Care Act mandates that Medicare dramatically reduce spending to help pay for federal subsidies in the new health insurance exchanges. One upshot: a massive “demonstration” to see if $248 million can be saved this year in the care of California’s oldest, disabled and poorest residents, including 200,000 in Los Angeles County.

Almost half of all individuals in the state who are eligible for both Medicare and Medi-Cal (aka Dual eligibles) benefits are being steered to special Medi-Cal managed care plans where their health needs are supposed to be coordinated, and where federal and state payments are limited to a set fee per patient, eliminating open-ended fees for services.

It sounds good, except that lots of vulnerable people — many in nursing homes or suffering cognitive impairment — suddenly find themselves stripped of their regular doctor, and facing a bureaucratic maze to get that care reinstated. MORE