State Moves Ahead with Dual Eligible Pilot Projects
The California Department of Health Care Services (DHCS) recently selected four California counties – Los Angeles, Orange, San Diego and San Mateo – to serve as pilot territories to shift “dual eligibles” (dually eligible for both Medicare and Medicaid) into Medi-Cal managed care plans. This shift has the potential to disrupt longstanding relationships between physicians and patients, especially in cases where the physician is not contracted with the county Medi-Cal managed care plan. Furthermore, dual eligible patients will be “passively enrolled” into the new managed care system, which will require many patients to affirmatively opt-out in order to maintain a relationship with their current physicians.
Additionally, Governor Brown has proposed expanding the current pilot to six additional counties – including Alameda and Contra Costa counties – as a means to achieve at estimated $1 billion in administrative savings. However, the nonpartisan Legislative Analyst’s Office has recommended rejecting the Governor’s proposed expansion until the results are known from the first four pilot projects.
During recent meetings with legislators that were held in conjunction with the CMA Legislative Leadership Day on April 17th, ACCMA members expressed concerns about expanding the pilot to the East Bay. Members explained how many dual eligible patients access physician services through their Medicare Part B coverage, and expressed a desire for continuing to give dual eligible patients a choice between fee-for-service and managed care. The ACCMA will be scheduling meetings with local Medi-Cal managed care plans to discuss these continuity of care concerns and explore opportunities for physicians to participate in those plans in an acceptable manner.