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 firstname.lastname@example.org by June 11.