California's three-year demonstration program for Medicare-Medicaid dual eligibles has been approved by the federal government.
Managed by the California Health and Human Services Agency and called the Cal MediConnect, the program will provide an integrated health plan to an estimated 456,000 Californians in eight counties, mostly in Southern California and the Bay Area.
Dual eligible patients account for an estimated 25 percent of California Medicaid spending, at least in part because of what Centers for Medicare & Medicaid (CMS) officials have called a financial misalignment between Medicare and Medicaid.
The health plans participating in the program will receive a blended capitation payment monthly from Medi-Cal and Medicare, with beneficiaries having a single membership card and access to a care coordination team
The MOU signed between CMS and the state calls for Cal MediConnect implementation to begin no earlier than October 2013, with phased-in enrollment for different counties.
The 456,000 Californians who will be transitioned to the program represent a little less than half of 1.2 million dual eligible patients in California (out of about 9 million nationally). California Gov. Jerry Brown had initially proposed transitioning 800,000 of those 1.2 million into the demonstration program.
In another change from the original proposal, the number of enrollees in Los Angeles County -- home to an estimated 271,000 dual eligible patients -- will be capped at 200,000.
"We are confident that the managed care plans we selected will make a positive impact on enrollees' lives by coordinating care across the full continuum of services, including medical care, behavioral health services and home- and community-based care, such as the In-Home Supportive Services program," Toby Douglas, director of the Department of Health Care Services, said in a media release. "Additionally, we have taken extensive measures to plan for and enforce strict quality and readiness standards."
The state is contracting with 12 health plans, including Health Net, Molina and Anthem Blue Cross.
For Health Net, Medicare-Medicaid dual plans have been a speciality and a potentially strong revenue source (amid earning struggles in other areas).
"That's an area where we think that there is real opportunity to really fundamentally change service for people" and improve care quality and efficiency, Health Net president and CEO Jay Gellert said on a conference call in January.