California’s Dual Eligibles Initiative Under National Spotlight December 6, 2012 Medi Cal, Medicaid, Medicare dual eligible initiative, Dual eligibles 0 Patient advocates across the nation are closely watching California’s transition of beneficiaries eligible for both Medicare and Medi-Cal from traditional fee-for-service plans to managed care plans. The California initiative is in its second year. State officials seek to transfer so-called dual eligibles to managed care plans to improve their health care services and reduce costs. The state has estimated that the initiative will save $663 million next year and that it will yield additional savings in subsequent years. Federal officials have begun implementing a similar national effort under a provision in the Affordable Care Act. Howard Kahn—CEO of L.A. Care, the largest public health plan in the U.S. with one million members in Los Angeles County—said the California initiative allows health plans to organize all of the care that dual eligibles receive and curb unnecessary treatments. However, some patient advocates who have followed the California initiative wonder if the federal demonstration project will put patients at too great a risk. A report released by the California HealthCare Foundation in August 2012 determined several problems with the transition, such as: A short timeline that allotted the state only seven months between federal approval and when enrollment began; Privacy rules that prevent some health plans from receiving complete patient records; Transfer guidance that confuses certain patients about whether their preferred physicians participate in various managed care plans; and, An appeals process that patients seeking exemption from the program find onerous. According to Kaiser Health News, California's initiative has caused some patients to leave trusted physicians and others to start receiving generic drugs that they say are ineffective. In addition, health experts have expressed concern that insurers participating in the initiative have little experience overseeing the long-term home care needs of certain dual eligible patients. Source: California Healthline, December 6, 2012. Comments are closed.
