December 12, 2014 – On November 13, 2014, the California Department of Health Care Services announced that the Coordinated Care Initiative will not move forward in Alameda County. As the state described it, this decision was made in coordination with the Department of Managed Health Care, Alameda Alliance for Health and local providers, and will allow Alameda Alliance for Health to focus on returning to fiscal health and transitioning out of conservatorship and back to local control.
What does this mean for the future for Alameda County seniors and the organizations that serve them? Some immediate questions can be answered; other implications will take time to realize. Click here to read some thoughts on “Where do we go from here?”
One consequence of Alameda County’s exclusion from the CCI is that seniors and people with disabilities who are dually eligible (Medi-Cal/Medicare) will have fewer options for affordable health and LTSS coverage in 2015. SSC has prepared a summary to help CBOs inform these consumers – as well as those with Medi-Cal only – about their options and where they can go to get help. Click here for the summary.
September 24, 2014 – Today Senior Services Coalition submitted comments to California’s Department of Health Care Services on the Draft Duals Plan Letter on D-SNPs in Alameda and Orange Counties. We voiced concern about the additional six month window of aggressive marketing targeting dual eligibles created by the postponement of the Coordinated Care Initiative/Cal MediConnect to July 2015.
Insurance brokers are not permitted to market CMC plans, and so are limited to enrolling dual eligibles into non-CMC D-SNPs in order to collect brokerage fees. The proposed policy invites insurance brokers to employ increasingly aggressive marketing efforts before the launch date to maximize enrollment into these plans.
While we didn’t propose a change to the policy regarding this concern, we strongly recommend that the state and CMS provide additional resources to local HICAPs so that they can to meet the demand for counseling assistance. Click here for a .pdf version of our comments.
August 15, 2014 – Last week, California’s Department of Health Care Services announced they will postpone the Alameda County and Orange County launch of the Coordinated Care Initiative until July 2015.
The Alameda County launch has been postponed half-a-dozen times since we received CCI and Duals Demonstration status in 2012. This final postponement, however, is the last, at least for the Duals Demonstration (now known as Cal MediConnect). After July 2015 the demonstration window closes and no new counties can enter until, presumably, California takes the next step, post-demonstration, in the planned CCI roll-out.
The state cited “plan readiness” (or lack thereof) as the reason for postponing the launch in both counties. In Alameda County, Alameda Alliance has been under state conservatorship since May, an action the state Department of Managed Care Services took citing Alliance’s low cash reserves and a claims backlog that was the consequence of a failed transition to a new IT system. While we haven’t seen the conservator’s 90 day report, we can presume that the schedule for Alliance’s return to fiscal stability is the reason for the state’s decision about plan readiness.
The Alliance’s conservatorship status was confirmed by a superior court judge on July 25 after hearing arguments against the takeover from the Alliance’s Board of Governors. The judge put a time constraint on the conservatorship: one year starting from the takeover date of May 5, 2014. It is the sincere hope of the aging services community that the Alliance will be returned to local control with its collaborative spirit and commitment to the community intact.
One question that the CCI postponement has left open is the status of Alliance’s Complete Care (its Special Needs Plan for Duals, or D-SNP). The Alliance had planned to close Complete Care and “cross-walk” its members into the new Cal MediConnect plan in January, and federal permission to do so is already in the works. With the announcement of the list of 2015 D-SNPs and other Medicare Plans just around the corner, a back-up plan will have to be adopted soon.
Timing, if the launch goes forward: A July launch date means that the first consumers to be subject to passive enrollment will receive letters in April, and packets with plan options and enrollment information in May.
Look for new training announcements and other resources from SSC in the first quarter of 2015. In the meantime, the new CCI Technical Advisor for Alameda County, Katharine Hsiao, and her colleague from Harbage Consulting, Shelly Grimaldi, will be reaching out to providers, CBOs and other community groups to ensure that these trusted sources are equipped to inform and assist seniors and people with disabilities, both this Fall and into 2015.
August 1, 2014 – A California Superior Court judge last week ruled the state may appoint a conservator to take over the troubled finances of Alameda Alliance, Alameda County’s local initiative health plan. The judge’s ruling approved the Department of Managed Health Care’s (DMHC) choice of Berkeley Research Group to serve as conservator of Alameda Alliance. The conservatorship will operate for a year, retroactive to, the day DMHC officials took over the finances of Alameda Alliance. To read David Gorn’s California Healthline article on the ruling and its impact, please click here.
July 24, 2014 – An issue brief from the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured gives us important insight into how CMS will be evaluating the Duals Demonstration in California and other states. The evaluation will be conducted over the course of the demonstrations, with frequent (quarterly) state-specific reports. Perhaps the most important take-away is that the evaluation will include both quantitative and qualitative methods, the latter based on site visits, interviews with state staff, beneficiary focus groups and stakeholder interviews.
May 22, 2014 – On May 7th, the Senior Services Coalition of Alameda County released a statement in response to the California Department of Managed Health Care’s action on May 6th to take possession of Alameda Alliance for Health due to financial solvency issues.
Wendy Peterson, Director of the Senior Services Coalition of Alameda County, made the “The Senior Services Coalition and the community-based organizations that are our members have high regard for Alameda Alliance for Health, the county’s local initiative health plan. This good will is a direct result of the many years of partnership and community engagement that the Alliance has undertaken as our county prepares for the launch of the Coordinated Care Initiative. We want to express clear recognition for Alliance’s collaborative, person-centered approach. We hope that as Alliance steers out of its current financial difficulties, it will be able to retain and continue to cultivate these strengths.”
Peterson added, “We think that Alliance shares our vision for a county where people can age in place, live with dignity, be part of a community, maintain health and mobility, and feel safe. In our county, about one in 8 people are over 65, and almost half of them are economically insecure. In the next six years, the over-65 population will grow by 30%. We need strong local partners , including the Alliance, to ensure that we are ready to address that tremendous growth. If we can help people age successfully, we will also be able to control costs.”
March 11, 2014 – Our colleagues at National Senior Citizen’s Law Center have clarified an aspect of coverage under the Affordable Care Act’s new Medi-Cal expansion, one particularly relevant to younger seniors and people with disabilities.
On January 1, 2014, thanks to the ACA, California began providing the full set of Medi-Cal health benefits to adults age 19 to 64 who are newly eligible under the expansion. Going through Covered California, these individuals are found eligible for Medi-Cal base on their incomes alone (under 138% of federal poverty level), with no asset test. The “expansion” benefits include coverage for Long Term Services and Supports (which include IHSS, CBAS/ADHC, MSSP and skilled nursing facility care).
DHCS wants to change this, and has sought federal approval of the State Plan Amendment (SPA) to require adults receiving Medi-Cal under the ACA expansion to meet the current established asset requirements in order to access LTSS. To date, CMS has not granted that request.
February 6, 2014 – Today the State Senate’s Budget Committee and Health Committee held a joint hearing on the Coordinated Care Initiative. The hearing was “informational” and reflects the legislature’s ongoing interest in overseeing the launch of this complicated initiative. he hearing was “informational” and reflects the legislature’s ongoing interest in overseeing the launch of this complicated initiative. The agenda and a video of the hearing are available by clicking here.
January 8, 2014 – The court settlement that preserved Medi-Cal coverage for Adult Day Health Care will expire on August 31, 2014. That settlement gave the benefit its new name – CBAS, for Community-Based Adult Services – and transitioned the benefit from Medi-Cal fee-for-service to a Medi-Cal Managed Care Plan benefit in Alameda and many other counties. The settlement thus gave CBAS the distinction of being the first LTSS to move into Medi-Cal Managed Care. It also bought time, enough to allow California’s Department of Health Care Services to change its opinion about eliminating the program.
In October 2013, DHCS acknowledged that “CBAS is a key component of LTSS under the Coordinated Care Initiative” and “an important Home and Community-Based Service that provides alternatives to institutional care.” More, DHCS and the California Department on Aging launched a CBAS Stakeholder Workgroup. Its purpose is to develop a future (post-settlement) direction for CBAS, and to prepare for amending the CBAS section of the federal 1115 Waiver (itself set to expire in August 2014).
This bodes well, as does the meaningful participation of an impressive and broad set of workgroup members. The Workgroup will meet three times (Jan. 9, Feb. 4 and March 6) before they must complete their deliverables in April. The door is open for the public and service providers to participate at the meetings (in person and by webinar), and to offer comments and recommendations in writing (by emailing CBAScda@aging.ca.gov) or by phone (916-419-7545) through April 2014.
November 4, 2013 – Concerned about the confusing messages that are flooding the press – and seniors’ mailboxes – regarding health coverage? You are not alone.
To address the confusion around health care coverage options in Alameda County, the Social Services Agency just released an updated Eligibility Chart to help social service providers identify coverage options for different people. Click here for a copy.
Also, our local HICAP provider, Legal Assistance for Seniors, has comparison charts for Medicare Advantage, prescription drug and MediGap plans on their web site at http://www.lashicap.org/hicap.
Here are some simple guidelines to point seniors in the right direction this Fall:
- If you have Medicare, you do not need to purchase any coverage through the state’s health insurance exchange, called Covered California. Medicare open enrollment (from October 15 through December 7) is still the time for you to review your health and prescription drug coverage and make any changes for next year. Contact medicare.gov or 1-800-MEDICARE for information, and call your local Health Insurance Counseling and Advocacy Program (HICAP) to get free, neutral help sorting through your options so you can make the choice that is best for you. In Alameda County, the HICAP number is (510) 830-0393. In Fremont, Hayward, Newark and Union City, seniors can also call the Senior Help Line at (510) 574-2041.
- If you have Medi-Cal, you do not need to purchase coverage through Covered California. Some changes in Medi-Cal coverage will start next year (as early as April 2014) for seniors and people with disabilities with Medi-Cal in Alameda counties, so watch your mail beginning in 2014.
- For people younger than 65 who don’t have health coverage, Covered California is the place to go to find affordable coverage. Subsidies to help pay premiums may be available, depending on your income, and new eligibility rules (for instance, no asset test) will mean more people will be able to enroll in Medi-Cal. Go to www.coveredca.com or call 1-800-300-1506.
- Beware of scams. People with Medicare and/or Medi-Cal do not need new identity cards, will not get calls from the government about their health coverage, and should never pay anyone to enroll in coverage. If you suspect a scam, call the Senior Medicare Patrol at 1-855-613-7080.
October 22, 2013 – To begin preparation for the Coordinated Care Initiative, the Senior Services Coalition is offering two trainings to cover who is affected, plan selection, consumer enrollment, exceptions and opting out, continuity of care, consumer rights and more. Both trainings will cover the same material.
October 2, 2013 – During the Department of Health Care Services’ first Coordinated Care Initiative stakeholder convening, two useful handouts were provided. The first is an update on general preparedness for the CCI’s launch and is available by clicking here. The second handout covers key outreach and education efforts thus far, and moving forward. That document is available by clicking here.
August 14, 2013 – Today staff from California’s Department of Health Care Services announced that the launch of the Coordinated Care Initiative will be delayed. The target launch date is now ‘no sooner than January July 2015′. This new launch date applies to all three components of the CCI — Cal MediConnect, moving Medi-Cal-covered long term services and supports into Managed Care, and mandatory Medi-Cal Managed care for virtually all Duals (people with both Medi-Cal and Medicare) and SPDs (seniors and people with disabilities who have only Medi-Cal coverage).
May 14, 2013 – For a clear and comprehensive understanding of the Duals Demonstration’s recently signed Memorandum of Understanding, The SCAN Foundation and National Senior Citizens Law Center (NSCLC) have created helpful summaries.
Both documents provide a background on the Duals Demonstration (now known as “Cal MediConnect”) as a whole, the scope of the implementation, the proposed timeline as well as eligibility details. Additionally, they provide details surrounding the enrollment processes, network adequacy, beneficiary protections and quality controls. To view The SCAN Foundation PDF, click here. To view the NSCLC PDF, click here.
March 27, 2013 – Today the Department of Health Care Services (DHCS) and the federal Centers for Medicare and Medicaid Services (CMS) announced that they have signed a Duals Demonstration Memorandum of Understanding (MOU). The Duals Demonstration is a key part of California’s Coordinate Care Initiative (CCI), and will integrate funding streams, health care, and Long Term Services and Supports for dual eligible beneficiaries.
The MOU does not address other parts of the CCI, such as the mandatory enrollment of Medi-Cal Only and Dual eligibles into Medi-Cal managed care, or the transition of Medi-Cal-covered LTSS in to managed care.
Looking at DHCS’s MOU Fact Sheet and CMS’s Announcement, there are significant changes from the state’s original proposal. What does the new MOU mean for Alameda County? Here are some highlights. We’ll have more in coming weeks.
- A new launch date of no sooner than
JanuaryApril 2014. In Alameda County most consumers would be passively enrolled over 12 months by birthday month, with some exceptions. For instance, consumers who are currently in Alameda Alliance for Health’s Duals Special Needs Plan (DSNP) will all be passively enrolled into Alliance’s Duals Demonstration Plan in MarchJune 2014.
- New Benefits – all participating plans are required to offer vision, dental, and non-emergency transportation benefits to enrollees.
- Beneficiary protections are consistent with other capitated Financial Alignment Demonstrations, and there will be Ombudsman services to support individual advocacy of Medicare-Medicaid enrollees and to identify systemic problems and provide oversight for the Demonstration.
- Continuity of Care Requirements are in place to help ensure enrollees do not experience disruptions in care through the transition period. Enrollees will have access to current providers and service authorizations for up to 12 months for Medicaid and up to 6 months for Medicare (more later on the criteria that must be met for this to happen).
- No lock in – Consumers will be able to opt out of the Duals Demonstration at any time or change Demonstration plans. Consumers who are in Medi-Cal Managed Care Plans will be able to change plans at any time (but would not be able to opt out of Medi-Cal Managed Care), and it is important to know that legislation is moving through the state legislature that would create an open enrollment period with lock-in for the rest of the year for all Medi-Cal consumers.
- Home and Community Based Waivers will remain open.
- The size of the Duals Demonstration is limited to 456,000 statewide, and capped at 200,000 in Los Angeles County. Based on a first look at the numbers, this limit will not affect Alameda County consumers’ ability to enroll in the Duals Demonstration.
February 28, 2013 – California’s Legislative Analyst’s Office (LAO) just released their updated analysis of the Coordinated Care Initiative. Click the LAO analysis here. The LAO warns that continued delay of a Duals Demonstration Memorandum of Understanding between the state and the federal government creates uncertainty regarding the timely and successful implementation of the CCI (currently scheduled for launch in Alameda County in January July 2015).
The LAO also states that “integration of IHSS under managed care is problematic” and recommends that the Legislature consider authorizing CCI to “test greater integration of In-Home Supportive Services… under managed care.” The current CCI legislation allows plans to increase, but not decrease, IHSS hours. The LAO’s troubling recommendation is to give at least one plan the ability to “fully integrate” IHSS (that is, the flexibility to increase AND decrease hours) during the third year of the demonstration.
In its recent analysis of the Governor’s proposed Health and Human Services budget, the LAO recommends that the pending 20% across-the-board cut to IHSS (currently blocked by a preliminary injunction), be repealed, in favor of extending the soon-to-expire 3.6% cut.
February 6, 2013 – The California Department of Health Care Services recently released two documents for comment: The California Duals Demonstration, Draft Policy for Demonstration Plans Offering Additional Home and Community-Based Services (HCBS) and the DRAFT HCBS Flow Charts. The Senior Services Coalition’s response to these documents can be found here.
January 16, 2013 – **Update: The Launch Date has been pushed back to no earlier than July 2015** Both the Duals Demonstration and Medi-Cal Managed Care LTSS were set to launch in eight counties – including Alameda County – as early as June 1, 2013. The Governor’s proposed budget had moved the launch date to January July 2015) and specifies that in Alameda County enrollment will be phased in over 12 months. With the changed launch date to July 2015, the first notices would go out in April 2015.
July 11, 2012 – The Governor’s Coordinated Care Initiative (CCI), included in the State’s FY 2012-13 Budget signed in June. It is a multi-year plan to coordinate health care and long term services and supports for dual eligibles (Medicare/Medi-Cal beneficiaries) and Medi-Cal Only seniors and people with disabilities. The CCI envisions all Medi-Cal long term services and supports coordinated within the framework of Managed Care.
The Duals Demonstration is the first phase of the CCI, and is now set to launch in eight counties – including Alameda County – no earlier than
January July 2014. The Demonstration will combine the two funding streams (Medi-Cal and Medicare) in Managed Care Plans that integrate medical and long term services and supports. It will require that dually eligible seniors and adults with disabilities enroll in a Medi-Cal Managed Care Plan. This enrollment will be mandatory, but individuals will have the option to “opt out” of the Demonstration and maintain their Medicare coverage on a fee-for-service basis. The Plans will be responsible not only for covering medical services, but for authorizing IHSS, MSSP, nursing facilities and CBAS/ADHC, and coordinating with other community-based services and supports.
The implementation of the Duals Demonstration plan is subject to approval by the Center for Medicare and Medicaid Services. Many of the important details of timing, enrollment and consumer protections are still being developed in conjunction with the state’s stakeholder workgroup process.