Policy Developments

February 28, 2013  –  California’s Legislative Analyst’s Office (LAO) just released their updated analysis of the Coordinated Care Initiative. See the LAO analysis here. The LAO warns that continued delay of a Duals Demonstration Memorandum of Understanding between the state and the federal government creates uncertainty regarding the timely and successful implementation of the CCI (currently scheduled for launch in Alameda County in April of 2014).

The LAO also states that “integration of IHSS under managed care is problematic” and recommends that the Legislature consider authorizing CCI to “test greater integration of In-Home Supportive Services… under managed care.”  The current CCI legislation allows plans to increase, but not decrease, IHSS hours. The LAO’s troubling recommendation is to give at least one plan the ability to “fully integrate” IHSS (that is, the flexibility to increase AND decrease hours) during the third year of the demonstration.

In its recent analysis of the Governor’s proposed Health and Human Services budget, the LAO recommends that the pending 20% across-the-board cut to IHSS (currently blocked by a preliminary injunction), be repealed, in favor of extending the soon-to-expire 3.6% cut.

Return to the Coordinated Care Initiative page here.

July 11, 2012 – The Governor’s Coordinated Care Initiative (CCI), included in the State’s FY 2012-13 Budget signed in June. It is a multi-year plan to coordinate health care and long term services and supports for dual eligibles (Medicare/Medi-Cal beneficiaries) and Medi-Cal Only seniors and people with disabilities. The CCI envisions all Medi-Cal long term services and supports coordinated within the framework of Managed Care.

The Duals Demonstration is the first phase of the CCI, and is now set to launch in eight counties – including Alameda County –  no earlier than January July 2014. The Demonstration will combine the two funding streams (Medi-Cal and Medicare) in Managed Care Plans that integrate medical and long term services and supports. It will require that dually eligible seniors and adults with disabilities enroll in a Medi-Cal Managed Care Plan. This enrollment will be mandatory, but individuals will have the option to “opt out” of the Demonstration and maintain their Medicare coverage on a fee-for-service basis. The Plans will be responsible not only for covering medical services, but for authorizing IHSS, MSSP, nursing facilities and CBAS/ADHC, and coordinating with other community-based services and supports.

The implementation of the Duals Demonstration plan is subject to approval by the Center for Medicare and Medicaid Services. Many of the important details of timing, enrollment and consumer protections are still being developed in conjunction with the state’s stakeholder workgroup process.

Here is a link to the state’s list of populations included and excluded from the Demonstration. **Note that this link does not include any changes from the new launch date of July 2014.**

The CCI legislation requires an IHSS maintenance of effort that would “hold county expenditures to the estimated level that would have occurred absent” the Demonstration. The legislation also includes the expectation that, at some point during the three year Demonstration, collective bargaining and employer-of-record responsibility will transfer from the county Public Authorities for IHSS to a state-wide Authority.

August 20, 2012  –  California’s Department of Health Care Services has scheduled two stakeholder meetings on the Draft Coordinated Care Transition Plan. The Plan describes how DHCS intends to implement several important elements of the Duals Demonstration: Maintaining access and quality; Implementing beneficiary protection provisions; Consumer complaints process; and Incorporating stakeholder feedback.

Seniors, people with disabilities, advocates and service providers in Alameda County are encouraged to participate in one of the two sessions. The meetings are planned for Wednesday August 29 from 11 am to 12:30 pm, and Tuesday September 4 from 1 to 2:30 pm. The Duals Demonstration will launch next year in Alameda and seven other counties.

Return to the Coordinated Care Initiative page here.

September 20, 2012  – California’s Department of Health Care Services has released more details about exactly who will be required to participate in the Coordinated Care Initiative (CCI), and has more clearly articulated the two major components of the CCI: 1) the Duals Demonstration, and 2) the Integration of Long Term Services and Supports into Mandatory Medi-Cal Managed Care. Both are coming to Alameda County no earlier than April 2014.

1) The Integration of LTSS into Mandatory Medi-Cal Managed Care: Starting some time in 2014, all seniors and people with disabilities who have Medi-Cal coverage will be required to enroll in a Medi-Cal Managed Care Plan, with only a few exceptions. Enrollment includes some who were left out of last year’s mandatory Medi-Cal Managed Care launch, most notably full Duals (with Medicare A, B and D), partial Duals (with A or B) and many with Medi-Cal Share-of-Cost (those who meet their share-of-cost every month).

Once the launch is complete, enrollment in a Plan (either Alameda Alliance for Health, Anthem Blue Cross) will be the only way to receive Medi-Cal’s long term care services such as IHSS, MSSP, ADHC, and skilled nursing facility care.

2) The Duals Demonstration: In addition to being required to enroll in Medi-Cal Managed Care, most dually eligible seniors and people with disabilities (age 21 or older) will also have a decision to make: whether or not to enter the Dual Demonstration. Read DHCS’s description of groups included and excluded from the Duals Demonstration and the Mandatory Medi-Cal Managed Care.

Return to the Coordinated Care Initiative page here.

October 19, 2012  –  The Center for Medicare & Medicaid Services recently released their 2013 quality star ratings for managed care plans. 2013 quality star ratings for Medicare health and drug plans. The rated plans selected to participate in California’s Coordinated Care Initiative (CCI) received an average rating of 3 out of 5 stars  Click here to link to the rating summary for California CCI plans.

The 5-star rating system is used by CMS to monitor plans to ensure that they meet Medicare’s quality standards. The ratings provide Medicare beneficiaries with a tool to compare the quality of care and customer service that Medicare health and drug plans offer. CMS’ star rating system considers 53 quality measures, such as success in providing preventive services, managing chronic illness, and keeping consumer complaints to a minimum.

Return to the Coordinated Care Initiative page here.

January 16, 2013 – **Update: The Launch Date has been pushed back to no earlier than July 2014** Both the Duals Demonstration and Medi-Cal Managed Care LTSS were set to launch in eight counties – including Alameda County – as early as June 1, 2013. The Governor’s proposed budget had moved the launch date to September 2013 July 2014 and specifies that in Alameda County enrollment will be phased in over 12 months. This means that the first notices that any beneficiaries would have received about the transition would arrive no earlier than June 2013 April 2014.

California’s Coordinated Care Initiative (CCI), included in last year’s FY 2012-13 Budget, is a multi-year plan to coordinate health care and long term services and supports for dual eligibles (Medicare/Medi-Cal beneficiaries) and Medi-Cal Only seniors and people with disabilities. The CCI has two major components. The first incorporates Medi-Cal-covered Long Term Services and Supports (IHSS, ADHC, MSSP and skilled nursing facility) into Managed Care. The second component, the Duals Demonstration, integrates Medicare and Medi-Cal coverage into Managed Care Plans that coordinate both medical and long term services and supports.

Return to the Coordinated Care Initiative page here.

July 10, 2012  –  The California Department of Health Care Services’ refusal to grant Medi-Cal CBAS eligibility to hundreds of medically complex and frail adults is threatening the viability of Adult Day Health Care in Alameda County. Here is a link to a Chronicle article about the crisis.

On June 27, 2012, Governor Brown signed the new Budget for California’s 2012-13 fiscal year. The Budget addresses a $15.7 billion deficit (up sharply from the $9.2 billion predicted in January, but now in alignment with Legislative Analyst’s projections). The Budget calls for $16.6 billion in cuts and revenue (leaving a $948 million reserve fund).  The plan includes:

• $6 billion in additional revenues from a November ballot measure asking voters to increase the sales tax by ½ percent and impose higher income tax rates on high-income Californians.
• $6.1 billion in “triggered” cuts to take effect on January 1, 2013 if voters don’t approve the November measure.
• $8.1 billion in cuts to CalWORKs, child care, Cal Grants, Medi-Cal, In-Home Supportive Services and other programs.
• $2.5 billion in loan repayment extensions, transfers and other one-time solutions.

The Budget follows years of reductions that have scaled back critical public programs and institutions. This policy-making has thrown the system of long term supports and services into chaos and put thousands of seniors and people with disabilities in peril… and it is not over.

Read more about the decisions enacted by the FY 2012-13 State Budget that would directly impact seniors and senior services in Alameda County.

Return to the State Budget page here.