The Department of Health Care Services (DHCS) announced that both parts of the Coordinated Care Initiative, including Cal MediConnect and Managed Medi-Cal Long Term Services and Supports (MLTSS), will begin no earlier than April 2014.
These programs represent a historic effort to integrate the medical, social, and mental health services provided to some of the most vulnerable members of society. The State is proud of the work that has been done so far, and is grateful for all of the stakeholder participation to move this effort forward.
Cal MediConnect is an opportunity to support people who have 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. The State, in coordination with CMS, decided to move the start date to give every issue the full consideration it deserves.
The State continues to place a high premium on beneficiary protections and is working deliberately to ensure a successful implementation.
DHCS continues to ask for stakeholders’ thoughts, feedback, and participation during this process.
Well, for providers like me, this is good news. Maybe they will come to their senses and either change the passive enrollment process or make exempt certain patients such as those in SNFs. They keep putting this off because the HMOs can’t handle all the incoming new patients. Just keep putting it off… for God’s sake!
Another temporary relief. It’s confusing because there are lot’s of changes going on at the same time, The Obamacare,Calduals,annual enrollment period for MAPD, mandatory enrollment for medi-cal, the implementation of ICD10, pending penalties for doctors not using EHR. There’s not enough doctors to see all this new patients.
I have two questions.
When a duals MediCal part is passively enrolled in a plan will their PCP be changed?
how long do they have stay with that PCP before going back to the original PCP if they are in a approved network.?
Can they change to MAPD plan at anytime?
Thank you,
Janice Wood
People always have the choice of their doctor. If someone elects to opt-out of Cal MediConnect, this is only possible on the Medicare side, they will still need to select a plan to manage their Medi-Cal and related services. If someone opts out of Cal MediConnect they will see their traditional, Fee-for-Service providers and would not need to change their PCP. If someone joins a plan, and their PCP is also in that network, they would be able to see that doctor and would not have to switch to another PCP. People can opt-out at any time, so someone could go from Cal MediConnect and join a MAPD plan as long as the MAPD plan was accepting enrollees at that time.
I agree with the idea of cal duals but as previously mentioned, too much going on at the same time. For a consumer on SSI with 3 children, all with health problems ranging from manageable GI issues to severely disabled and on palliative care, it all becomes too much. One fact sheet says someone is excluded because of a waiver or organization they’re in and another says they’re included because of the same programs. How can one make the right decision that can benefit an entire family like mine with confusing information? Not to mention the fact that all our case managers have contradicting information and sometimes are not as up to date as I am. I’m definitely not the only one under these circumstances so what are we to do?
Is there any truth to the rumor that is going around which “we will be forced to go into managed care and not be given the choice to live indepently?
If so, what can the benificary of IHSS do to prevent this, so wee can live indendently?