DHCS Seeking Feedback on Cal MediConnect Enrollment Changes

The Department of Health Care Services (DHCS) is seeking feedback from stakeholders on whether the Cal MediConnect enrollment period should be updated to be consistent with the new Medicare enrollment rules or seek a waiver to maintain the continuous Special Election Period (SEP) for Cal MediConnect plan choice.

Historically, a key beneficiary protection in Cal MediConnect has been the beneficiary’s ability to make enrollment changes monthly. This was based on enrollment policies in both Medi-Cal and Medicare allowing this population (dual eligibles) the ability to change plans or return to fee-for-service Medicare without limits on a monthly basis. This is known as a “continuous” Special Election Period (SEP) in Medicare.

Medicare recently finalized a regulation for 2019 with a number of changes, including new limits on the continuous SEP for dual eligibles. Under the new regulations, dual eligibles would be limited to changing Medicare plans just once a quarter for the first three quarters of each calendar year. This is in addition to other SEPs that will stay in place, such as moving out of service area or to enroll in PACE (Program of All-Inclusive Care for the Elderly).

DHCS is requesting input from stakeholders on whether Cal MediConnect should be updated to be consistent with the new Medicare rules or seek a waiver to maintain the continuous SEP. While the limits to the continuous enrollment period might promote beneficiary stability, it would be a significant change to beneficiary choice protections.

Please submit any comment on this potential change to Cal MediConnect enrollment periods to info@calduals.org by June 11.

  1. Felicia Valentina

    As the relative of a recently deceased dual eligible beneficiary, I am strongly opposed to any further erosion of the patient’s right to opt out of the Medicare advantage plans at any time. I encourage DHCS to seek a waiver to maintain continuous choice.

    Upon learning my relative had cancer, opting out of MediConnect allowed for her to receive immediate access to a fine panel of physicians, therapeutic radiology at a Cancer Center that did not accept Medicare Advantage plans, and highly rated hospitals. This simply would not have occurred had she remained in a MediConnect plan.
    Restrictions to beneficiary choice can result in significant harm to the patient and possible death.

    • Kristine Loomis

      Thank you for making this clear. I am involved with communications around Cal Medi-Connect and I know that this decision would be a step backwards. Particularly as it is coupled with the proposal to involve Brokers.
      Your personal testimony is highly appreciated!

  2. Kristine Loomis

    I am shocked and concerned about the lack of time and transparency allowed for stakeholder input to this process. It should be given more time and public involvement.
    I have been heavily involved in the stakeholder process for CCI since 2013 (Chaired the Riverside/San Bernardino CCI Advisory Committee for a couple years and am still a current member). I’m also a Medi-Cal/IHSS consumer (person with disability) impacted by these changes. I am strongly in favor of seeking an exception to the restriction on beneficiary opt out. I am also strongly against allowing Brokers to enter this complex enrollment process that has such control over our medical services and outcomes. Particularly given the proposed policy that does not require IN PERSON CONFIRMATION by the beneficiary.
    From Day One of CCI, the difficulty for consumers has been Continuity of Care. Relationships with doctors are developed over years, and particularly for those of us with complex medical conditions, these relationships are HARD WON. The one year Continuity of Care extension is not adequate to mitigate the necessity of transitioning to an unknown doctor. The number and quality of doctors can be very limited in some CCI counties and locations. ANY financial incentive that goes against flexibility and sensitivity to our care can be life threatening to fragile beneficiaries. Many of us do not have unlimited access to care providers that have our best interest at heart and time to understand complex case management issues that are unfortunately part of Managed Care.
    These latest proposals are financially driven; brokers take resources from the program that could be put to better use. Forcing beneficiaries to stay in a Plan longer than they wish to, or signing them up without their full understanding is not in anyone’s best interest. I predict it will ultimately INCREASE costs. But as with many of these practices, the metrics are not tracked accurately. Do you track increased acute/emergency care or end-of-life as part of the cost? Policy decisions should be based on statistics that include health outcome results – NOT only enrollment figures and how those impact the “bottom line”.
    Thank you for the opportunity to participate in this process. I would advise you extend the comment period so that others such as organizations who require opt-in and approval processes can have time to do so.

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