Another delay for the Cal MediConnect project for dual eligibles February 12, 2014 Medi-Cal, Medicare Medi-Cal, Medicare, Dual Eligible, Insurance/Reimbursement 0 The California Department of Health Care Services (DHCS) recently announced yet another delay for the Cal MediConnect project for dual eligibles. Implementation in Orange County has been delayed indefinitely, following a Centers for Medicare and Medicaid Services (CMS) audit of CalOptima—which is the county's only Medi-Cal managed care plan. The audit uncovered a number of serious issues that must be resolved before the duals transition can move forward in Orange County. Previously, Orange County was scheduled to begin passive enrollment on April 1, 2014. According to DHCS, implementation of Cal MediConnect in Orange County has been delayed indefinitely while CalOptima takes corrective action as directed by CMS. Because patients in Orange County have already received the 90-day notice, CalOptima will be sending a follow up letter to notify them that their coverage is not changing. These letters are expected to be mailed by end of next week. Patients who are currently enrolled with CalOptima will continue to receive medical benefits and coverage. DHCS last week announced that passive enrollment has been delayed by one month in Riverside, San Bernardino and San Diego counties, and is now set to begin in May. These delays are in addition to previous notice of delays in Santa Clara, Alameda and Los Angeles counties. DHCS also announced it would be adding additional plans in Los Angeles County (CareMore, Care 1st and Molina). The Cal MediConnect project was authorized by the state in July 2012 in an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities. The program begins with a three-year demonstration project that would see a large portion of the state's dual eligible beneficiaries transition to managed care plans. The project will impact approximately 450,000 duals in eight counties – Alameda, Los Angeles, Orange, Riverside, San Diego, San Mateo, San Bernardino, and Santa Clara. DHCS will be notifying affected patients 90, 60 and 30 days prior to their passive enrollment date. San Bernardino and Riverside Counties: Inland Empire Health Plan and Molina Dual Options, voluntary enrollment period begins no sooner than April 1, 2014; passive enrollment begins no sooner than May 1, 2014. For more information on the duals demonstration project, visit www.cmanet.org/duals and www.calduals.org. Comments are closed.
