From our colleagues at CA DHCS: 

The Department of Health Care Services (DHCS) is re-releasing the draft Los Angeles County Enrollment Strategy for public comment. Comments on previous versions of the proposal were received in July 2013 with 28 entities responding and December 2013 with 18 entities responding. Important changes in LA County have lead DHCS to re-releasing the LA enrollment document prior to finalization. Understanding this policy has gone through many iterations, DHCS will continue its efforts to inform and assist beneficiaries to understand the enrollment process in LA County. 

In designing Cal MediConnect, DHCS relied on the existing Medi-Cal model of managed care, with LA Care and Health Net serving the Cal MediConnect population as they serve Medi-Cal today in Los Angeles County. While LA Care received 3.5 Medicare stars for Part C, other Medicare quality measures resulted in LA Care being unable to accept passive enrollment for Cal MediConnect as planned. Under today’s announcement, DHCS will offer beneficiaries a greater choice of Cal MediConnect plans in Los Angeles County.  In addition to Health Net and LA Care, three other plans will be offered.  

To preserve the Two Plan Model while moving forward with Cal MediConnect, DHCS has developed a solution specific to Cal MediConnect.  For Cal MediConnect beneficiaries, California will passively enroll beneficiaries directly into Cal MediConnect eligible plans-CareMore, Care 1st, Molina, and Health Net-no sooner than July 2014. To be eligible, a plan must be a Medi-Cal participating plan, a Medicare participating plan, and have undergone Cal MediConnect plan readiness review.  Once LA Care improves its Medicare quality rating, LA Care would be eligible to begin receiving passive enrollment. 

DHCS will be hosting a call on Monday, February 24th, from 12 – 1 pm to solicit comments and answer questions about the LA Enrollment Strategy. To participate on the call, please sign up here.

Sincerely,

Jane Ogle
Deputy Director, Health Care Delivery Systems

Department of Health Care Services

Click the following link for Enrollment Strategy for Los Angeles County into Cal MediConnect released by California Department of Health Care Services:

http://www.calduals.org/wp-content/uploads/2014/02/REVISED-LA-Enrollment-Strategy-2.19.14-2.0.pdf

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  • LAAAC is managed by St. Barnabas Senior Services; Funded, in part, by Archstone Foundation.
  • St. Barnabas Senior Services

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