Oppose Expanding Mandatory Managed Care for Dual Eligibles
The California Legislature is considering a proposal to force “dual eligibles” – patients covered through both Medi-Cal and Medicare – into Medi-Cal managed care, including in Alameda County. This could seriously disrupt access and continuity of care for our most vulnerable patients.
CMA is opposing this proposal and is urging physicians to contact members of the California Assembly and Senate to express your opposition. Call 877-362-8455, enter your zip code, and you will be connected to your legislator.
The state already has the authority to pursue pilot projects in four counties to evaluate how mandatory managed care for dual eligibles impacts cost savings and healthcare delivery. The four pilot counties have been selected, and the projects are slated to begin in early 2013. But even before these projects have started, the Governor has proposed increasing the number of pilot counties to 8 counties in 2013 (including Alameda County), 22 counties in 2014 (including Contra Costa), and all California counties in 2015.
When you call your legislators, tell them your name, specialty and that you are a constituent. In addition, here are talking points to assist with your phone calls:
- Dual eligibles - some of California’s most vulnerable patients - have longstanding relationships with their physicians that could be disrupted with disastrous consequences.
- The state is supposed to be doing “pilot projects to learn about the best ways to care for dual eligibles", but instead is picking one way – managed care – before the pilot projects have started
- Dual eligibles currently have the option to choose managed care, and they should continue to have the option between managed care and fee-for-service
- The purpose of this proposal is to take choices away from our most vulnerable patients - choices about the type of coverage they receive, and about which doctors they see
Although phone calls are most effective, emails and faxes are helpful as well. Please go to www.accma.org to access a sample fax letter and sample email letter. You can also find your legislators' contact information.
As a voter in your district, I am writing to express my serious concern regarding the proposal to force those on both Medicare and Medi-Cal (“dual eligibles”) into managed care plans.
This proposal will cause serious disruption for dual eligible patients. Many of these patients have been seeing the same physicians for years, if not decades. If those physicians do not contract with the plan, all of that patient’s medical history could be lost.
Moreover, this proposal will force many patients into managed care plans whether they want to join them or not. In fact, if the patient does not speak English, or does not see their mail, they may not even know that their coverage is changing. This can lead to confusion for both the patient and their providers.
(If you have specifics about your practice or patients, insert them here)
Right now, Medi-Cal cannot even tell us how this transition will work, or how patients can opt out of being enrolled. And yet, they are proposing to begin forcing patients into plans early next year.
I am urging you as my state legislator to ask Medi-Cal to slow down implementation of the dual eligibles project, and to reject any proposal to expand the project further. Medi-Cal needs to start with a much smaller and more thoughtful project, so patients are not hurt by this transition.