DHCS Releases Proposed LA County Enrollment Strategy

Today, the Department of Health Care Services (DHCS) released the draft Los Angeles County Enrollment Strategy for public comment. DHCS has worked to design a strategy that ensures a successful transition for eligible beneficiaries.

This policy takes into account the recently released policy around Medicare Advantage D-SNPs (Dual Eligible Special Needs Plans), as outlined in the recent legislation.

DHCS places a high premium on beneficiary protections and is designing policies to ensure a successful implementation of the program.

Additionally, DHCS leaders will host a call to discuss the proposal with stakeholders. This 60 minute call is scheduled for Wednesday, July 17th, from 2-3pm.

To participate in this call, please register here.

Comments on this proposal should be submitted via this form by Friday, August 2nd to info@calduals.org.

 

  1. PSYD

    My anecdotal evidence of ths program benefitting only the HMOs, while negatively impacting individuls who participate in it, is based on the following: I’ve spoken to 12 nursing home DONs, 11 nursing home admins, 10 primary doctors 12 psychiatrists and 10 psychologists. None of these individuals are in favor of this program. We all feel it will be catastrophic for patients who take on an HMO on the Medicare side. It will also have a huge negative impact on providers. Here’s the good news: I’ve spoken to 20 of my patients thus far and not a single one wants to change the way they are receiving medical and psychological services. They all have told me that they will opt out of this program. I believe that most individuals will opt out when they realize that they won’t be able to see their doctor unless said doctor is affiliated with an HMO. Every provider must notify their patients of the November letters being sent by the State. This passive enrollment for this program is unethical in my opinion. HMOs are really playing dirty and practicing illegal methods to gain patients. I know of one facility where LA Care took over an entire assisted living facility by signing up the entire house of about 60 individuals. They convinced the people, many of whom are chronically mentally ill, to sign up with them. This is wrong, unethical and illegal. This is what we will be up against as providers. Please pass this on. Thanks for the opportunity to express my opinion.

  2. Gordana Vukotich

    Dear All –

    We presented the CCI What do Doctors Need to know document to our 8 Board Members. 6 are primary care physicians with a large population of Duals in the Mid-Wilshire district of LA.

    One of our PCP’s has had a significant number of duals enroll with open of our plan partners (We are also contracted with LA Care and Health Net), only to see the members disenrollment the Medicare. The fact that the duals can opt out of their Medicare has made this a challenge. Frankly speaking there is concern that the pilot will have similar results to the Cal Optima – One Care enrollments a few years ago.

    On behalf of the SMG PCP’s and board –

    In summary, it is almost like a revolving door for some PCPs’, and becoming difficult to manage.

    The pilot would have made more sense if the mandatory enrollment into managed care, for the duals, included Medicare for those who are not share of cost.
    Thank you,
    Gordana

    • BTM

      I am a Medi-Medi client in Los Angeles and I am dealing with several medical issues and working with a great team of doctors at Cedars Sinai to solve these issues. I thank the heavens each day that I will be able to opt out on the Medicare side otherwise I would be forced to start over with doctors who do not know my history or my condition. I am also glad the start date got pushed to April 2014

  3. PSYD

    Thanks be to God that they can disenroll from the Medicare side. The state should be ashamed of themselves for this unfair and unethical passive enrollment. The HMOs will provide inferior care and 99% of Medi-Medi patients who are with it enough cognitively know it!

    • HeckNoHMO

      PSYD, I completely agree. We will be educating as many Medi-Medi patients as we can to warn them they will lose current physicians over this as well as freedom to access care. I am aware of one patient already who got lost in the Medi-Medi-to-HMO jumble & could not follow up with his retina physician. Language barriers, age, confusion and inability to find an MD on his plan soon enough added up to a loss of eyesight. This rush to “coordinate care” under the guise of doing what’s best for the patient is a crock. It’s all about money & control. Save money at the expense of our most vulnerable population, and funnel thousands of patients out of private practices where physicians maintain a scrap of autonomy & patients get to see who they wish when they wish, into managed care (rationed care) where a gatekeeper has the say-so over when they can see a specialist. It is only then that most of them find out their cardiologist or ophthalmologist does not take HMO plans and they can no longer be cared for by the doctor(s) they know and trust. This is a horrible thing to do to senior and disabled patients. Just because they are lower income does not mean they should be herded like cattle onto inferior care so-called health plans. It’s discrimination against the poor, the elderly and the disabled all in one fell swoop. We will be distributing flyers to dual eligible patients warning them of this impending doom so they have a change at deciding their fate rather than having it handed to them by the government. Yes, the world is firmly within the handbasket now.

      • PSYD

        Love what you wrote. Say “NO, NO NO to the HMO.”

  4. DD

    PSYD especially, you’re comments are based on self interest. Many thousands of people are with Medicare HMO’s and it’s a great program overall.

    I am neither a provider or a patient.

    We all know that medi-medi’s are the most vulnerable and are not able to effectively manage their own health care. Why should medi’s get care differently from Commercial Health Plans. This program is a test to find the best way to cut costs and have healthier population. It won’t be perfect but the medi’s will get greater benefits and have someone to talk to about their many issues and many doctors who are not able to talk to one another.

    If you are worried about losing patients then join up with one of the 6 providers. Don’t mislead your patients because of self interest.

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