The Centers for Medicare and Medicaid Services released a Memorandum of Understanding (MOU) it has entered into with the California Department of Health Care Services on the Duals Demonstration Project that seeks to test a new model for providing more patient-centered, coordinated care to Medicare-Medicaid enrollees. Moving forward, the pilot program will be called Cal MediConnect.

California is the fourth state with approval for a capitated demonstration to better integrate and coordinate care delivery for Medicare-Medicaid enrollees. The demonstration includes eight counties, including Los Angeles, Orange, Riverside and San Bernardino Counties, and approximately 456,000 beneficiaries will be eligible.

Key MOU highlights:

Timeline: Enrollment in Cal MediConnect will begin no earlier than October 2013. Beneficiaries would begin receiving notices about their choices and upcoming changes no earlier than July 2013.

Enrollment Strategies: The MOU describes the enrollment strategy for each of the eight counties. For Los Angeles County, enrollment will be over a 15-month period. Voluntary enrollment will take place from October to December 2013. Starting January 2014, beneficiaries will be passively enrolled. A comment period will be undertaken to determine an enrollment strategy (ex. birth month, geography etc.).

In Orange County, the CalOptima board of directors is expected to make a final go/no-go decision to participate in the Demonstration in June, once rates are available from the state. Passive enrollment will commence October 1, 2013 under a birth order strategy. The CalOptima board of directors has approved an open network, which will allow several pathways for physician participation, including direct contracting with the agency outside of health networks. This is intended to preserve patient choice and minimize the likelihood of patients opting out due to lack of participation by their physicians.

In Riverside and San Bernardino Counties, enrollment will occur over a 12-month period; the goal is an October 1 start date.

Size of the Demonstration: The MOU allows for 456,000 total beneficiaries to be eligible for enrollment into the Cal MediConnect program. This is almost half the size called for in the Governor’s 2012-2013 budget. The MOU does cap enrollment in Los Angeles County to no more than 200,000 beneficiaries. In Orange County, the target population numbers 57,000. Riverside County has 35,000 and San Bernardino County has 36,000 eligible for the demonstration project.

Stable Enrollment Period: Beneficiaries who enroll in Cal MediConnect can opt out at any time; there will be no stable enrollment period.

Download the CMS fact sheet.

Cal MediConnect will conduct readiness reviews of the selected health plans; finalize capitation rates, and execute a three-way contract and continue to develop the operational systems needed for activities like enrollment, monitoring and evaluation. Additional details on the MOU will be circulated to hospitals after it is fully analyzed.

Contact: Jaime Garcia
(213) 538-0702, jgarcia@hasc.org