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.
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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 inMarchJune 2014. -
New Benefits – all participating plans are required to offer vision, dental, and non-emergency transportation benefits to enrollees.
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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.
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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).
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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.
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Home and Community Based Waivers will remain open.
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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.
Click here to download the state’s MOU Fact Sheet. Click here to go to the MOU Document.
Return to the Coordinated Care Initiative page here.