New Data on California’s Duals Demonstration Population

The Department of Health Care Services (DHCS) has released several new reports that use a comprehensive set of 2010 data to provide descriptive statistics and insights into the population eligible for participation in California’s proposed demonstration to coordinate Medicare and Medi-Cal services for dually eligible beneficiaries.

Created by DHCS’ Research and Analytic Studies Branch (RASB), the reports and pivot tables are part of our effort to inform all stakeholders, ensure a smooth transition, and help contracting health plans prepare their operations for the demonstration.

View and download reports and tables here.

The reports highlight the high burden that California Medicare and Medicaid beneficiaries face from chronic diseases. The data reinforce the need for effective care coordination — the cornerstone of the proposed demonstration.Pending federal approval, this demonstration would give beneficiaries the opportunity to combine their Medi-Cal and Medicare benefits into one health plan and receive more coordinated and accountable care than available in today’s fragmented health care delivery system.

The reports and data explore questions about the eligible population, such as:

• How many eligible beneficiaries reside in the eight demonstration counties?
• What is the chronic disease burden among those eligible?
• What are their utilization patterns and cost differences?
• What are the demographic characteristics and differences between the eligible populations across the eight counties?

Some key facts about the population eligible for California’s duals demonstration are highlighted below. 

• The demonstration population is smaller than originally estimated. California has about 1.2 million dual eligible beneficiaries, but less than half of those people (about 526,900) are eligible to participate in the demonstration. This lower estimate reflects all the populations excluded, such as beneficiaries with developmental disabilities or without full Medicare benefits. (Medi-Cal’s CCI Population, pages 4, 65)

• Many eligible participants already use managed care. About one-third of the population is already enrolled in some form of managed care, either Medicare Advantage, Medi-Cal managed care, or both.(Medi-Cal’s CCI Population, page 67)

• Concurrent chronic conditions are common. Among beneficiaries currently not enrolled in managed care, 44 percent were treated for three or more conditions. The complexity and cost of caring for people with multiple conditions is significant, with costs increasing by 50 percent from a person with one condition to someone with two conditions. County-specific disease burden information is provided and can be helpful guidance to health plans and community-based organizations. (Eight County Profiles,page 3)

• Use of long-term services and supports (LTSS) varies. About 57 percent of the eligible participants currently in fee-for-service used no LTSS in 2010. About 36 percent used home-and community-based LTSS, and 5 percent were residents in a skilled nursing facility. (Medi-Cal’s CCI Population, pages 111-112, 161)

• Behavioral health conditions are highly prevalent and a major cost driver, with greater frequency for beneficiaries age 21-65. The data on schizophrenia, mood disorders, depression and drug and alcohol dependency indicate a strong need to ensure that behavioral health care is properly integrated with a beneficiary’s overall care.(Medi-Cal’s CCI Population, pages 114-121 and 128-130)

• The demonstration population is diverse. English is the primary language for less than half of people eligible for the demonstration. Spanish, Vietnamese, Armenian and Cantonese are the most common languages spoken other than English. About 60 percent of eligible beneficiaries are women, 40 percent are disabled, 75 percent are age 65 or older, and 40 percent are age 75 or older. (Medi-Cal’s CCI Population, pages 85-87)

When reading the report, please keep in mind that the report focuses on findings for the entire population eligible for the demonstration in some sections and in others draws on data only from the population currently not in managed care. This is noted in the reports. The fee-for-service population available for analysis in Orange and San Mateo counties was small due to their existing models of mandatory managed care.