National Council on Medicaid Home Care Issues Brief on California Dual Eligible Initiative
July 2, 2013 02:17 PM
In the first week of June, California’s Department of Health Care Services (DHCS) announced several revisions to its dual eligible demonstration (the Demonstration). The revisions come on the heels of two letters, written on June 4 and May 2, to federal and state administration officials criticizing the Demonstration and providing further recommendations.
The recent revisions to the Demonstration by DHCS include:
“De-linking” mandatory enrollment from the Demonstration
A“poison pill” that would allow the state to review the Demonstration project annually, and to terminate it completely if the required savings aren’t realized; and
Expanding Medicare Advantage enrollment in the Demonstration (in the MOU, they were initially exempted from passive enrollment).
Jane Ogle, the deputy director of DHCS, defended the “de-linking” as good for long term services and supports (LTSS), which will now be MediCal benefits.
The other revisions were met with criticism. DHCS justified the “poison pill” as not only appropriate if savings aren’t realized, but if a sudden lack of federal or state funding threatens the Demonstration. Bill Barcelona, SVP for public affairs at the California Association of Physician Groups criticized the “poison pill” as essentially allowing unilateral termination of the MOU by California’s Department of Finance.
Some also saw moving Medicare Advantage beneficiaries into the Demonstration as unhelpful. Barcelona felt that the purpose of the Demonstration is to coordinate care, which he asserted Medicare Advantage already accomplishes effectively.
The National Council for Medicaid Home Care, a NAHC affiliate, recently released a brief examining the revisions, as well as the main criticisms highlighted in the two letters. The full brief can be found here.