In an open letter to members of the California State Legislature, nearly twenty organizations representing a wide variety of health care stakeholders urged their representatives to oppose Governor Brown’s dual eligible proposal. The proposal would move patients eligible for both Medicare and Medi-Cal into a Medi-Cal Managed Care program, ultimately disrupting care and harming patients.
Members of the California State Legislature,
In 2010, the Legislature gave the Department of Health Care Services (DHCS) authority to undertake pilot projects to redesign care and treatment for vulnerable seniors enrolled in both Medicare and Medi-Cal, the “dual eligibles.” The pilot projects were supposed to take place in up to four counties, and seniors would be given the opportunity to opt out if they wanted to stay with their doctors.
Before these pilot projects have even started, Governor Brown has proposed to rapidly expand them, to eight counties initially and statewide over the next two years. The plan for this transition is contained in a trailer bill to the State Budget, and a related proposal that has been submitted to the federal government. It has been titled the “Coordinated Care Initiative.”
We, the undersigned organizations, are asking the legislature to deny the Governor’s request to expand the dual eligible projects, and to request that DHCS work with the legislature and stakeholders on true pilot projects to test different ways of delivering the best care to vulnerable seniors.
1) This is no longer a “pilot project” or a “demonstration project.”
Just the four counties authorized in existing law – Los Angeles, Orange, San Diego, and San Mateo – account for almost half of the state’s dual eligible population. With an additional four counties –Alameda, San Bernardino, Santa Clara, and Riverside – the projects will include almost 70% of the state’s dual eligible population.
This can no longer be called a “pilot project” or a “demonstration project.” It simply includes too much of the target population. If the state generates lessons learned through the project, there will be no opportunity to apply changes.
2) DHCS is proposing to passively enroll seniors into the dual eligibles into the project, and it is not clear how they’re going to do it.
Under this program, seniors will have the right to opt out and stay in traditional Medicare. But to exercise that right, seniors will have to be aware of what is happening and what paperwork they will need to complete. This information should be available as soon as possible, and available in multiple formats and languages.
As of the writing of this letter, DHCS has not even developed a draft of the form that seniors will use to select a plan or opt out. Preventing seniors from exercising any choice will result in this medically vulnerable population losing access to longstanding relationships with their providers.
3) The duals proposal must be seen in the context of other DHCS programs and proposals.
Right now, the state is completing the transition of 400,000 seniors and persons with disabilities (SPDs) into Medi-Cal managed care. They are now proposing to shift 1.2 million dual eligibles, more than 800,000 children on Healthy Families, and hundreds of thousands of patients in rural counties.
In total, Medi-Cal is proposing to shift more than 3 million beneficiaries between now and 2015. We do not believe that DHCS can shift all of these beneficiaries in this incredibly tight timeline without causing massive disruptions in care.
With all of the above in mind, the undersigned organizations ask the Legislature to reject the Coordinated Care Initiative trailer bill when it is presented as part of the State Budget. We further ask that legislators urge the Department of Health Care Services to withdraw their overly-ambitious 4-county proposal to the federal government and take more time to develop a scaled-down project that gives seniors and the professionals that take care of them information and feedback mechanisms to assure continuity of care and true improved care coordination.
We look forward to working with you.
California Medical Association
American Congress of Obstetricians & Gynecologists, District IX
Association of Northern California Oncologists
California Academy of Eye Physicians and Surgeons
California Academy of Family Physicians
California Academy of Physician Assistants
California Association for Health Services at Home
California Medical Transportation Association
California Podiatric Medical Association
California Psychiatric Association
California Radiological Society
California Society of Anesthesiologists
California Society for Dermatology and Dermatologic Surgery
California Society for Physical Medicine and Rehabilitation
IHSS Consumers Union
Medical Oncology Association of Southern California
Pharmaceutical Research and Manufacturers of America
Polio Survivors Association