The Department of Health Care Services (DHCS) announced on Monday that Cal MediConnect will begin no earlier than January 2014.
Cal MediConnect represents a historic effort to integrate the medical, social, and mental health services provided to some of the most vulnerable members of society. Already, there has been an impressive amount of work completed moving California toward this goal, including stakeholder support and participation, which moves this effort forward.
Cal MediConnect is an opportunity to support people who have both Medicare and Medicaid with more coordinated care. Doing so requires work on multiple levels between governments, health plans, and communities. This kind of systematic change takes time, and therefore the new timeline provides the opportunity to give every issue the full consideration it deserves.
The state places a high premium on beneficiary protections and is working deliberately to ensure a successful implementation. DHCS will continue assessing readiness for implementation and the final start date.
Does this mean the dual integration in Alameda County CA is not going to take place until then also?
Does this mean the dual integration in Alameda County CA is not going to take place until then also?
Many thanks to DHCS for taking the initiative in providing integrated, social, medical, and mental health services to the most vulnerable mebers of the society. Good things are never too late.
With all due respect, I couldn’t disagree more with your statement. This program will only hurt “duals” who end up having an HMO on both their Medicare side and Medi-Cal side. I’ve talked to many, many doctors, SNFs and nurses who agree with this opinion. The only ones who will benefit will be the HMOs. You can count on it.
This is a fantastic endeavor that State of California and the federal government is undertaking.
This will help out the medicare- MediCal Population by giving them managed care and additional benefits like transportation, dental, glasses, and maybe chiropractor, and acupuncture among other benefits.
No, you are wrong, John R. If you read the fine print and go through all the DHCS documents pertaining to this policy, you will realize that patients would gain very little out of this than you make it seem. First of all, none of the Cal Mediconnect plans have acupuncture, routine chiropractic, or any type of bonus benefits not already given to those with Medicare and Medi-Cal alone, with the exception of modest dental and vision benefits, only from mostly Medi-Cal dentist and doctors, as well as some transportation benefits. In fact, the initial proposal when this idea was first conceived around 2012 did not include ANY extra benefits whatsoever in addition to Medicare and Medi-Cal standard benefits, and the only difference being that it would be managed care instead of FFS to save gov’t money. It wasn’t until a year later that they decided they should probably include a few extras in addition to bare-bones Medicare/Medi-Cal coverage in a managed care plan, probably so as to make it seem comparable to most MA plans.
If you’re like me and a huge fan of MA products, there have been many Medicare Advantage plans for years that provide these types of extra benefits you mention, like acupuncture, including the special needs plans for dual eligibles. The problem with the CCI proposal is that they plan to phase out such Medicare HMO d-SNP plans for dual eligibles in CCI counties in lieu of these inferior CMC plans that come with far fewer perks like gym membership/fitness classes. How ironic and hypocritical of them to try to promote coordination of care while simultaneously stripping beneficiaries of their Medicare special needs plans that they’ve already selected to coordinate their care. My point is, if I’m already in a plan, why do they need to take it away so that I’m forced into something I don’t want like CMC or FFS Medicare with only managed Medi-Cal. I will do whatever it takes to escape this, that I’ve even gone so far as to change my address so that I don’t “live” in L.A. County anymore.
Many thanks to DHCS for taking the initiative in providing integrated, social, medical, and mental health services to the most vulnerable mebers of the society. Good things are never too late.
With all due respect, I couldn’t disagree more with your statement. This program will only hurt “duals” who end up having an HMO on both their Medicare side and Medi-Cal side. I’ve talked to many, many doctors, SNFs and nurses who agree with this opinion. The only ones who will benefit will be the HMOs. You can count on it.
This is a fantastic endeavor that State of California and the federal government is undertaking.
This will help out the medicare- MediCal Population by giving them managed care and additional benefits like transportation, dental, glasses, and maybe chiropractor, and acupuncture among other benefits.
No, you are wrong, John R. If you read the fine print and go through all the DHCS documents pertaining to this policy, you will realize that patients would gain very little out of this than you make it seem. First of all, none of the Cal Mediconnect plans have acupuncture, routine chiropractic, or any type of bonus benefits not already given to those with Medicare and Medi-Cal alone, with the exception of modest dental and vision benefits, only from mostly Medi-Cal dentist and doctors, as well as some transportation benefits. In fact, the initial proposal when this idea was first conceived around 2012 did not include ANY extra benefits whatsoever in addition to Medicare and Medi-Cal standard benefits, and the only difference being that it would be managed care instead of FFS to save gov’t money. It wasn’t until a year later that they decided they should probably include a few extras in addition to bare-bones Medicare/Medi-Cal coverage in a managed care plan, probably so as to make it seem comparable to most MA plans.
If you’re like me and a huge fan of MA products, there have been many Medicare Advantage plans for years that provide these types of extra benefits you mention, like acupuncture, including the special needs plans for dual eligibles. The problem with the CCI proposal is that they plan to phase out such Medicare HMO d-SNP plans for dual eligibles in CCI counties in lieu of these inferior CMC plans that come with far fewer perks like gym membership/fitness classes. How ironic and hypocritical of them to try to promote coordination of care while simultaneously stripping beneficiaries of their Medicare special needs plans that they’ve already selected to coordinate their care. My point is, if I’m already in a plan, why do they need to take it away so that I’m forced into something I don’t want like CMC or FFS Medicare with only managed Medi-Cal. I will do whatever it takes to escape this, that I’ve even gone so far as to change my address so that I don’t “live” in L.A. County anymore.
I agree with PSYD’s statement. This program will only hurt “duals” who end up with 2 HMO’s. Many will lose their PCP and specialists. If this works like many of the MediCal managed care plans individuals with serious medical problems will be assigned to Pediatricians or to Women’s Health Clinics (I’m talkng about men)with limited access to specialists. I have seen this happen multiple times. Only the HMO’s will benefit.
Please inform as many as you can of the downside to this program.
I agree with PSYD’s statement. This program will only hurt “duals” who end up with 2 HMO’s. Many will lose their PCP and specialists. If this works like many of the MediCal managed care plans individuals with serious medical problems will be assigned to Pediatricians or to Women’s Health Clinics (I’m talkng about men)with limited access to specialists. I have seen this happen multiple times. Only the HMO’s will benefit.
Please inform as many as you can of the downside to this program.
My guess, members will continue to have access to their providers as they currently do with an open network although it’s identified as a medicare hmo.
My guess, members will continue to have access to their providers as they currently do with an open network although it’s identified as a medicare hmo.
Specialty care in the nursing facility will be wiped out unless a complete plan is put in place. If done right it will improve care but i am concerned about the alternative which would be devastating to patient care.
Specialty care in the nursing facility will be wiped out unless a complete plan is put in place. If done right it will improve care but i am concerned about the alternative which would be devastating to patient care.
I believe this program will hurt only duals and benefit to
HMO.
I believe this program will hurt only duals and benefit to
HMO.
This is a tragic change with huge implication to people who really need care, the elderly. As a specialist (doctor) this program scares me as many of my patients will be forced to be seen by others who may not provide the needed care. I have tried hard to fight this as many of my patients, just like Manuel are clueless as how this will change their care. This change shifts all the power to the insurance companies and big hospitals. This will cause a ripple affect of increase wait time and decrease in proper care. Doctors will be force to see a lot of patient hence a decrease in quality of care. Overall not a great program.
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Hola! I’ve been reading your site for a while now and finally got the bravery to go ahead and give you a shout out from Humble Texas! Just wanted to tell you keep up the fantastic work!
Hi! This is my 1st comment here so I just wanted to give a quick shout out and
tell you I genuinely enjoy reading through your blog posts.
Can you recommend any other blogs/websites/forums that go over
the same topics? Thanks a ton!
Hi! This is my 1st comment here so I just wanted to give a quick shout out and
tell you I genuinely enjoy reading through your blog posts.
Can you recommend any other blogs/websites/forums that go over
the same topics? Thanks a ton!
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.
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.