California's Coordinated Care Initiative
by Amber Cutler, Esq.
The Coordinated Care Initiative (CCI) is a new state program, now set to begin no sooner than April 1, 2014, that will redesign the delivery of health care services to approximately one million individuals living in eight California counties: Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara. Consumer representatives need to get ready for this massive change.
To really understand what the CCI is and who is affected, we have to travel back in time to 2010 and the passage of the Affordable Care Act (ACA). The ACA created a Medicare-Medicaid Coordination Office (MMCO) charged with improving coordination of health benefits for individuals with both Medicare and Medicaid (dual eligibles). Dual eligibles are among the highest need and highest-cost demographic in our health care system. It is widely believed that changes in the delivery model for dual eligibles could bring savings because these individuals currently access their services through a fragmented system of different programs and government offices. With the goals of decreasing healthcare spending and increasing care coordination for this population, the MMCO created an opportunity for states to develop demonstration projects for dual eligible beneficiaries that would integrate Medicare and Medicaid programs.
After two years of discussions, California enacted legislation to move forward with a demonstration project integrating Medicare and Medi-Cal benefits into managed care plans for dual eligibles living in eight California counties. On March 27, 2013, the State and the MMCO entered into a Memorandum of Understanding (MOU) to move forward with California's dual demonstration, now called Cal MediConnect. Of the over 20 state proposals for demonstration projects, California‘s is by far the largest. California also decided that, along with a demonstration for duals, it would integrate long-term services and supports into managed care for all dual eligibles and seniors and persons with disabilities (SPDs)(1) living in these eight counties under a larger program, the Coordinated Care Initiative.
The CCI therefore is an umbrella program that encompasses three major changes:
1. Mandatory enrollment in Medi-Cal managed care. With few exceptions, all Medi-Cal beneficiaries in the eight counties will be mandatorily enrolled in a managed care plan for their Medi-Cal benefits.
2. Integration of Long-term services and supports (LTSS). LTSS will be integrated into the Medi-Cal managed care benefit package. Accordingly, health plans will be responsible for providing In-Home Supportive Services (2), Community Based Adult Services, Multi-Purpose Senior Services Program benefits, and nursing facility benefits.
3. Cal MediConnect. Most dual eligibles will be automatically enrolled into a Cal MediConnect plan that combines their Medicare and Medi-Cal benefits. Beneficiaries will have one card and will access all of their Medicare, Medi-Cal, including LTSS, through the health plan.
Approximately 418,000 dual eligible beneficiaries will be automatically enrolled into Cal MediConnect if they do not affirmatively choose not to participate in the program. Those who decide not to participate in Cal MediConnect will still have to enroll in a managed care plan for their Medi-Cal benefits. An additional 592,000 dual eligibles and SPDs who are not eligible for Cal MediConnect will be mandatorily enrolled in Medi-Cal managed care.(3)
There have been several updates and modifications to the CCI since the MOU was signed in March 2013. The most significant change was a decision by the legislature that individuals who are enrolled in a Medicare Advantage plan4 would not be automatically enrolled in Cal MediConnect in 2014. These individuals will not receive notices about Cal MediConnect, but will, however, be required to join a managed care plan for their Medi-Cal benefit.
The implementation date of the CCI has also moved several times. Most recently, the State announced that the CCI will not begin prior to April 1, 2014. Advocates welcome this additional time to prepare for this monumental transition. The CCI is a complex program that will impact individuals differently depending on what services they currently receive. Beneficiaries, their family members, and representatives will face multiple choices about their health care needs. For this major change to move forward smoothly, it is imperative that individuals who work with duals eligibles and SPDs understand these changes so they can assist beneficiaries in navigating this new program.
The National Senior Citizens Law Center has published an Advocate's Guide to California's Coordinated Care Initiative available at http://dualsdemoadvocacy.org/california. We also encourage you to visit www.calduals.org.
1 “SPD” is a specific term under the CCI. It refers to individuals who only qualify for Medi-Cal, not Medicare, and are eligible for Medi-Cal based on age or disability.
2 Counties will remain responsible for assessing IHSS need and paying for IHSS. Plans will be responsible for coordinating this benefit for beneficiaries. Beneficiaries will retain the right to hire, fire and supervise their IHSS providers.
3 Individuals who only qualify for Medicare will not be impacted by the CCI.
4 This includes individuals enrolled in a Dual Eligible or Chronic Condition Special Needs Plan (D-SNP, C-SNP).
Amber Cutler, Esq. is staff attorney with NSCLC. She will be discussing the CCI in further detail at CANHR’s Elder Law Conference in November.