California Healthline: State Alters Rollout of Duals Project

by David Gorn

State health officials yesterday announced several changes to the April 1 launch of the duals demonstration project in California.

The pilot program to coordinate care for the estimated one million Californians dually eligible for Medicare and Medi-Cal benefits will initially target roughly 400,000 people in seven counties. The first step is to automatically move dual eligibles into managed care plans — a process known as passive enrollment.

An eighth county, Orange County, was part of the original rollout plans but CMS officials recently deemed the CalOptima health plan was not prepared to handle the Medicare side of the transition and it will likely be excluded from the duals project until at least January, 2015, state officials said. CalOptima was the only insurer lined up for the duals pilot in Orange County.

CMS also found fault with LA Care, one of two health plans participating in the duals project in Los Angeles. LA Care is not prohibited from participation but federal officials will not allow it to passively enroll beneficiaries until January, 2015.

That restriction prompted one of yesterday’s announced changes, which included:  


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