Governor released his 2017-18 budget proposal which continues Cal MediConnect and MLTSS.
The State and DHCS are committed to increasing and improving the coordination of care for dual-eligible individuals. The budget reflects the Administration’s commitment to the principles of the CCI and making the necessary changes in order to make the Cal MediConnect program stronger.
When created, the Coordinated Care Initiative (CCI) contained a provision requiring the Department of Finance to determine if the CCI program is cost effective each January, and if not, the entire program would be discontinued the following year.
The Budget estimates that CCI will not be cost effective, thereby triggering a process that ceases all statutory provisions related to CCI as of January 1, 2018. Until then, DHCS is taking this opportunity to restructure parts of the program to make it cost effective.
Based on the lessons learned from CCI, the Budget proposes to extend the Cal MediConnect program, continue mandatory enrollment of dual-eligibles, and continue to integrate long-term services and supports (except IHSS) into managed care for two years. Some of the pieces of the CCI were found to be cost-effective and have the potential to improve the quality of care for those enrolled, and help keep individuals in their homes and communities, thereby leading to likely long term cost reductions.
Other changes under the Budget include:
- IHSS would no longer be included as a health plan benefit, but would continue to be available to eligible beneficiaries as a fee-for-service benefit, just as it was before implementation of the CCI
- Funding changes implemented under the CCI would end, and funding for IHSS would no longer be included in the capitation rates for plans
- Plans and counties would be encouraged to collaborate on care coordination
- DHCS, in conjunction with the Department of Aging (CDA), is proposing to delay for two years the transition of the Multipurpose Senior Services Program from a fee-for-service benefit to a benefit fully supported under the managed care plans
- Considering the budget proposal, the State does not plan to proceed with the Universal Assessment Tool. However, the State recognizes that a number of the proposed items developed through this process cover important topics that could be useful if addressed during the IHSS in-home assessment, and plans to assess if and how they may be leveraged by the IHSS program.
DHCS has been open about the challenges that have come with trying to integrate two very different health care systems in a way that provides improved and better coordinated care. We will continue to work closely with our plan, provider, and stakeholder communities as any changes to the program are rolled out.
To listen to a recording of the stakeholder call on 1-12-17 which discusses the budget announcement, click here.
Everyone knew it would fail except those who created this unethical program.
why is it unethical?
It’s unethical because this program in its first two years passively enrolled people into it. That means that if potential CCI patients didn’t fill out a letter sent by the state to them, they were automatically placed into an HMO on their Medi-Cal and Medi-Care. Many duals are either chronically mentally ill or have dementia and couldn’t fill out the letter or didn’t understand what to do. Thus, they were placed into HMOs. HMOs are the worst! I’ve seen people die because of their lack of response time. Traditional Medicare is the BEST insurance there is. Period!
The problem with the Medicare-Medi-Cal dual program is it violates the basic tenets of the Affordable Care Act. I am under 65, disabled, and should not have to be forced to change doctors with whom I have had a long-standing relationship with to go to a inferior HMO group situation. To do so means that finding qualified specialists is much harder. Secondly they will want to redo tests done numerous time and that is unacceptable. Thirdly, who has the time, strength and patience to be kept in a waiting area with the general population, exposed to who knows, when you have a life-threatening illness. HMO do not work, they limit the patient, often violating the right to get a second opinion, to see specialists outside the network, and to see your primary care doctor to get permission to see a specialist is an absolute waste of time. The concept for an HMO was coordinated care, but even with medical records online, the doctors do not share, even in Kaiser, so if the patient isn’t on top of keeping the various physicians up to date, the doctors do not, there is the number one problem. Healthcare should not be a “profit” business, it is a service to the population, and when treatment is denied as medically unnecessary (which is illegal in CA), and the CEO’s of the insurance companies are giving themselves million dollar bonuses, there is a moral and ethical issue that is ignored by the State and Federal bureaucracies. Patients are consumers and in truth, the employer and should stand up for their rights and get what they deserve since they are paying for it. Whether a doctor or a politician, hold them accountable.
Everyone knew it would fail except those who created this unethical program.
why is it unethical?
It’s unethical because this program in its first two years passively enrolled people into it. That means that if potential CCI patients didn’t fill out a letter sent by the state to them, they were automatically placed into an HMO on their Medi-Cal and Medi-Care. Many duals are either chronically mentally ill or have dementia and couldn’t fill out the letter or didn’t understand what to do. Thus, they were placed into HMOs. HMOs are the worst! I’ve seen people die because of their lack of response time. Traditional Medicare is the BEST insurance there is. Period!
The problem with the Medicare-Medi-Cal dual program is it violates the basic tenets of the Affordable Care Act. I am under 65, disabled, and should not have to be forced to change doctors with whom I have had a long-standing relationship with to go to a inferior HMO group situation. To do so means that finding qualified specialists is much harder. Secondly they will want to redo tests done numerous time and that is unacceptable. Thirdly, who has the time, strength and patience to be kept in a waiting area with the general population, exposed to who knows, when you have a life-threatening illness. HMO do not work, they limit the patient, often violating the right to get a second opinion, to see specialists outside the network, and to see your primary care doctor to get permission to see a specialist is an absolute waste of time. The concept for an HMO was coordinated care, but even with medical records online, the doctors do not share, even in Kaiser, so if the patient isn’t on top of keeping the various physicians up to date, the doctors do not, there is the number one problem. Healthcare should not be a “profit” business, it is a service to the population, and when treatment is denied as medically unnecessary (which is illegal in CA), and the CEO’s of the insurance companies are giving themselves million dollar bonuses, there is a moral and ethical issue that is ignored by the State and Federal bureaucracies. Patients are consumers and in truth, the employer and should stand up for their rights and get what they deserve since they are paying for it. Whether a doctor or a politician, hold them accountable.
The only reason they are scraping this program is a 1.9 billion dollar accounting “MISTAKE”, I DO NOT call this a mistake, I call it like it is GOV STUPIDTY!!! Brown covered this “mistake” up for months tryng to keep it all under cover until the new state budget came around so he could bury it so deep it was”nt found. well guess what MOONBEAM YOU GOT BUSTED, just another stupid dem that needs to be removed from office.
You are right on… but the Dems run this State. Are you a provider?
The only reason they are scraping this program is a 1.9 billion dollar accounting “MISTAKE”, I DO NOT call this a mistake, I call it like it is GOV STUPIDTY!!! Brown covered this “mistake” up for months tryng to keep it all under cover until the new state budget came around so he could bury it so deep it was”nt found. well guess what MOONBEAM YOU GOT BUSTED, just another stupid dem that needs to be removed from office.
You are right on… but the Dems run this State. Are you a provider?
As one who operates a program directly affected by CCI, I have to say it is one of the biggest mistakes ever made by a bunch of bureaucrats (interestingly all of whom are now retired) who know nothing about direct client care. Managed Care in this state as it now exists is neither managed nor provides quality care. It was purely an exercise in attempting to squeeze any remaining money our of an already underfunded system. Fortunately the State could not require the dual eligible population (those folks eligible for both Medi-Cal and Medicare)to sign away their Medicare benefits and the so called “duals” program is rapidly becoming an “unos” program.
Another grand scheme designed by office workers in Sacramento who had nothing better to do then attempt to screw those who need health care services, Fortunately, the legislature inserted a poison pill that if the plan lost money it would come to an end. This exercise in bad management has cost us thousands of non-governmental money but what is worse is that care has not been adequate provided to many of California’s most frail older residents.
^^^^This is right on! As a provider, I fought this unethical program from day 1. It has clearly been a failure.
As one who operates a program directly affected by CCI, I have to say it is one of the biggest mistakes ever made by a bunch of bureaucrats (interestingly all of whom are now retired) who know nothing about direct client care. Managed Care in this state as it now exists is neither managed nor provides quality care. It was purely an exercise in attempting to squeeze any remaining money our of an already underfunded system. Fortunately the State could not require the dual eligible population (those folks eligible for both Medi-Cal and Medicare)to sign away their Medicare benefits and the so called “duals” program is rapidly becoming an “unos” program.
Another grand scheme designed by office workers in Sacramento who had nothing better to do then attempt to screw those who need health care services, Fortunately, the legislature inserted a poison pill that if the plan lost money it would come to an end. This exercise in bad management has cost us thousands of non-governmental money but what is worse is that care has not been adequate provided to many of California’s most frail older residents.
^^^^This is right on! As a provider, I fought this unethical program from day 1. It has clearly been a failure.