CPMA Joins CMA in Opposing Proposed Changes to Duals Demonstration


California's Department of Health Care Services (DHCS) recently released a series of proposals that would change the Coordinated Care Initiative (CCI) enrollment process to 1) increase enrollment; 2) passively enroll beneficiaries into Cal MediConnect; and to 3) streamline enrollment by allowing plans to eliminate or dramatically reduce the role of the enrollment broker.

The Coordinated Care Initiative was authorized by the state in July 2012 in an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities. The program began with a three-year demonstration project that expected to see a large portion of the state's dual eligible beneficiaries transition to managed care plans.

Experience shows that passive enrollment strategies result in high opt-out rates, confusion, disruption in care, distrust of managed care and high costs to plans.

CPMA is concerned that these proposals are being made in-spite of a report released in January of this year by RTI International showed that California and other states had reported that it was proving to be more costly and challenging than expected to coordinate care for individuals who are dually eligible for Medicare and Medicaid.

Report Details, Findings

For the report, researchers examined dual eligible demonstration programs in operation as of May 1, 2014, in:

  • California;
  • Illinois;
  • Massachusetts;
  • Minnesota;
  • Ohio;
  • Virginia; and
  • Washington.

The researchers found that the states:

  • Faced conflicting Medicare and Medicaid policies concerning eligibility criteria and enrollment;
  • Had to manage a large influx of enrollees at one time;
  • Had staff spend "an inordinate amount of time trying to locate enrollees in order to complete initial health assessments and introduce enrollees to the benefits of the demonstration;" and
  • Were surprised by the cost of adapting their technology systems to implement the demonstration programs.

Overall, the researchers reported that "addressing the nuts and bolts of aligning the Medicare and Medicaid program policies, procedures and systems has been more time-consuming than [states] expected."

Throughout the development of the Coordinated Care Initiative, DHCS and the Centers for Medicare and Medicaid Services (CMS) repeatedly promised to protect beneficiaries through the complicated transition into managed care. Yet, DHCS and CMS moved forward with program implementation, ignoring stakeholder recommendations to slow down and conduct additional systems testing. As a result, beneficiaries experienced significant disruption and confusion, and anticipated enrollment goals were not met.

Today, two years into implementation, health plans are just starting to deliver the coordination of benefits promised under this new delivery model. The new enrollment proposals ignore DHCS’s own evaluation data and threaten to revert CCI back