Monday, April 9, 2012 The CSAC Bulletin
State Picks First Four Counties for Duals Demonstration Project
On April 4, the Brown Administration announced the selection of four demonstration sites for the Dual Eligible Demonstration Project. The sites are Los Angeles, Orange, San Diego and San Mateo counties.

Existing law allows up to four demonstration sites to improve care coordination for individuals receiving both Medi-Cal and Medicare – known as dual eligibles. The four counties selected are home to 537,000 of the 1.2 million dual eligible beneficiaries and approximately half of the monthly long-term care utilization.

Projects are slated to begin January 1, 2013. Beneficiaries would be notified in the fall of 2012. The Duals Demonstration Project would expand the managed care benefits to include the In-Home Supportive Services (IHSS) program, as well as Multipurpose Senior Services Programs (MSSP), Community-Based Adult Services, and skilled nursing facility services.

The Duals Demonstration expansion is one of the January budget proposals that are part of the Administration’s Care Coordination Initiative focused on changes to the Medi-Cal program.

The Administration is continuing to seek legislative approval to expand the number of demonstration sites to 10 in 2013; the state indicated if the expansion is approved, it could include Alameda, Contra Costa, Riverside, Sacramento, San Bernardino and Santa Clara counties. The expansion to ten counties would also require federal approval, readiness reviews and preparations. As envisioned by the Governor, an additional 20 counties would have duals demonstration projects begin in 2014. The project would then be expanded to all counties in 2015.

The following details the plans submitted by county:

County Managed Care Type Applications
Alameda Two-Plan Model Alameda Alliance for Health
Anthem Blue Cross
Contra Costa Two-Plan Model Contra Costa Health Plan
Los Angeles Two-Plan Model L.A. Care
SCAN Health Plan
Health Net
Orange County Organized Health System CalOptima
Riverside Two-Plan Model Inland Empire Health Plan
Molina Healthcare
SCAN Health Plan
Sacramento Geographic Managed Care Molina Healthcare
San Bernardino Two-Plan Model Inland Empire Health Plan
Molina Healthcare
SCAN Health Plan
San Diego Geographic Managed Care Care 1st
Community Health Group
Health Net
Molina Healthcare
SCAN Health Plan
San Mateo County Organized Health System Health Plan of San Mateo
Santa Clara Two-Plan Model Anthem Blue Cross
Santa Clara Health Plan

CSAC, along with county affiliates and consumer groups, has expressed concerns with the Administration’s aggressive timeframe and the overall proposal. CSAC is not opposed to the demonstration projects – we understand the importance of better coordinating and integrating care. However, expanding the duals project before getting data, outcomes and evaluation on the demonstration project is premature. The Administration wants to go from a handful of pilots to statewide implementation in two years. The Legislative Analyst’s Office (LAO) also released a report in February outlining a number of concerns, which mirror ours.

There will be a number of fiscal issues for counties participating in the pilots to address. The Administration is proposing that the county share of IHSS be used to fund the capitated rates for the health plans. The Administration wants Department of Finance to negotiate a Maintenance of Effort (MOE) level for each county. The MOE would be based on how the IHSS program would have grown (caseload and utilization) absent the demonstration. The MOE would change if there are changes other than caseload and utilization changes (i.e. wages and/or benefits changes).

Additionally, the Administration has expressed interest in using county behavioral health dollars to fund the capitated rate. At this point, that appears to be an option that would be negotiated locally between county mental health and the health plans. However, there is not much of detail regarding how behavioral health will be addressed in the projects – other than clarification that behavioral health is part of the demonstration.

Further details on how the demonstration would be implemented are described in a comprehensive proposal released today in draft version for public comment. Following a 30-day period for stakeholder input, California will submit this proposal to CMS for approval.
For more information about the demonstration, please visit www.CalDuals.org. All the health plan applications may be viewed online.