California Healthline: Changes Afoot for Orange County Duals

by David Gorn, California Healthline Sacramento Bureau

range County is slated to start enrollment this week in the Cal MediConnect duals demonstration project.

The Cal MediConnect demonstration project is designed to enhance care and integrate coordination for duals by combining the financing and services of Medicare and Medi-Cal, California’s Medicaid program. It was launched with eight target California counties in 2014 with the goal of eventually expanding Cal MediConnect to all the roughly one million dual-eligibles in the state.

Orange County, one of the eight counties initially participating, encountered a few obstacles and is now the last one to launch its Medi-Cal managed care plan for Californians dually eligible for Medicare and Medi-Cal. All duals in Orange County will be enrolled in the project automatically, unless they opt out of it — a system known as passive enrollment.

The state Department of Health Care Services announced a different kind of delay for part of the project in Orange County — a plan to offer extended outreach to some of the most fragile duals. Those living in long-term care facilities will get an extra three months before passive enrollment begins.

The shift in long-term care facility residents’ enrollment initially caused some consternation in the senior advocacy community, but state officials and health insurers said they just want to take more time to reach out to residents of those facilities, to make sure those frail and elderly patients understand the benefits of Cal MediConnect.

“I wouldn’t call it a delay,” said Michael Schrader, CEO of CalOptima, the sole Medi-Cal managed care insurer in the Orange County duals project. “It’s a strategy that comes from lessons learned in other counties. … It’s a strategic decision to help minimize the opt-out rate, which has been especially high at long-term care facilities.”

Concerns and Assurance

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