Duals Demonstration MOU Signed

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 January April 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 March June 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.

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.

In-Home Supportive Services Settlement

**Update – April 10, 2013** NSCLC has prepared a notice about the settlement for consumers and providers, download it here.

March 20, 2013 – A settlement has been reached in the law suit to stop the State of California from reducing In-Home Supportive Services hours and services. The cuts had been enacted in the state’s FY 2011-12 budget and FY 2009-10 budget, but were blocked by court injunction. The Governor’s proposed FY 2013-14 budget still assumed the state would win the suit and implement the cuts.

In the settlement, the State has agreed to repeal and eliminate two major cuts to IHSS: (1) the 20% across-the-board reduction in IHSS hours from 2011, and (2) the termination or reduction in IHSS for many recipients based on their functional index score from 2009.

Instead, the settlement:

  • Replaces the permanent 20% cut in IHSS hours with a temporary 8% cut in July 2013. (This is an additional 4.4% on top of the 3.6% current cut that was scheduled to expire in June.)
  • Reduces the total cut to 7% in July 2014.
  • Restores the hours lost from the 7% cut as early as the spring of 2015 if the State obtains federal approval of a provider fee which could bring significant new federal revenue to California.
  • Commits any savings from retroactive federal approval of the new provider fee to fund a program to benefit IHSS recipients, such as the SSI Special Circumstances program, which was used to pay for refrigerators and stoves, rent to avoid eviction and other emergency needs but has not been funded in the budget for many years.
  • Clarifies that IHSS consumers have a right to request a reassessment based on a change in circumstances, even if this change is not medical. Recipients will not be required to provide medical certification of a change in their medical condition to obtain a reassessment. This will help ensure that consumers who need additional hours will be able to obtain them.

We’ll have more details soon.

The settlement resolves a second lawsuit that challenged a cut to IHSS worker wages that was enacted in the state’s FY 2009 budget (a cut that was also blocked by the courts). The state agreed to rescind its reduction of the “state participation” share of IHSS worker wages.

The settlement is expected to win approval by the court.  The additional cuts in hours will cause hardship for many people who rely on IHSS, yet in light of the alternative, today’s settlement represents an important victory in protecting seniors, children and adults with disabilities from the terrible consequences of short-sighted public policy decisions. The plaintiffs in the suits were represented by lawyers from Disability Rights California, National Senior Citizens Law Center and others, and our hats off to them for this important accomplishment.

Return to the State Budget page here.

California’s Legislative Analyst’s Office Updated Analysis

February 28, 2013  –  California’s Legislative Analyst’s Office (LAO) just released their updated analysis of the Coordinated Care Initiative. See 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 April of 2014).

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.


Return to the Coordinated Care Initiative page here.

Introduction to the CCI

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.

Here is a link to the state’s list of populations included and excluded from the Demonstration. **Note that this link does not include any changes from the new launch date of July 2014.**

The CCI legislation requires an IHSS maintenance of effort that would “hold county expenditures to the estimated level that would have occurred absent” the Demonstration. The legislation also includes the expectation that, at some point during the three year Demonstration, collective bargaining and employer-of-record responsibility will transfer from the county Public Authorities for IHSS to a state-wide Authority.

Return to the Coordinated Care Initiative page here.

Draft Coordinated Care Transition Plan

August 20, 2012  –  California’s Department of Health Care Services has scheduled two stakeholder meetings on the Draft Coordinated Care Transition Plan. The Plan describes how DHCS intends to implement several important elements of the Duals Demonstration: Maintaining access and quality; Implementing beneficiary protection provisions; Consumer complaints process; and Incorporating stakeholder feedback.

Seniors, people with disabilities, advocates and service providers in Alameda County are encouraged to participate in one of the two sessions. The meetings are planned for Wednesday August 29 from 11 am to 12:30 pm, and Tuesday September 4 from 1 to 2:30 pm. The Duals Demonstration will launch next year in Alameda and seven other counties.


Return to the Coordinated Care Initiative page here.

CCI Participant Details

September 20, 2012  – California’s Department of Health Care Services has released more details about exactly who will be required to participate in the Coordinated Care Initiative (CCI), and has more clearly articulated the two major components of the CCI: 1) the Duals Demonstration, and 2) the Integration of Long Term Services and Supports into Mandatory Medi-Cal Managed Care. Both are coming to Alameda County no earlier than April 2014.

1) The Integration of LTSS into Mandatory Medi-Cal Managed Care: Starting some time in 2014, all seniors and people with disabilities who have Medi-Cal coverage will be required to enroll in a Medi-Cal Managed Care Plan, with only a few exceptions. Enrollment includes some who were left out of last year’s mandatory Medi-Cal Managed Care launch, most notably full Duals (with Medicare A, B and D), partial Duals (with A or B) and many with Medi-Cal Share-of-Cost (those who meet their share-of-cost every month).

Once the launch is complete, enrollment in a Plan (either Alameda Alliance for Health, Anthem Blue Cross) will be the only way to receive Medi-Cal’s long term care services such as IHSS, MSSP, ADHC, and skilled nursing facility care.

2) The Duals Demonstration: In addition to being required to enroll in Medi-Cal Managed Care, most dually eligible seniors and people with disabilities (age 21 or older) will also have a decision to make: whether or not to enter the Dual Demonstration. Read DHCS’s description of groups included and excluded from the Duals Demonstration and the Mandatory Medi-Cal Managed Care.


Return to the Coordinated Care Initiative page here.