California is one of fifteen states that have been approved to create a demonstration project that will attempt to integrate and coordinate care for people who are eligible for Medicaid and Medicare (dual eligible). Up until now, dual eligibles have been exempt from managed care because of the complexity of their health care needs as well as the complexity of combining two sets of benefits and two payment systems into a coordinated model of care.

The concept of integrating care for this population, which is typically sicker and poorer than those who have either Medicaid or Medicare alone, is important because, at best, it can be confusing to rely on two sets of benefits and, at worse, there can be a disconnect between the two causing disruption in care.  However, integration also brings challenges.

Monitoring these projects is important for people with HIV because about 80% of people with HIV who receive Medicare are also eligible for Medicaid (Medi-Cal in California). California has created a series of stakeholder meetings and work groups to plan for this demonstration project but serious concerns remain.

California plans to use passive enrollment, which means that people are auto-enrolled into a managed care plan, with a window of time during which they can opt-out. After the opt-out period there is a six month “lock in” – this means that people won’t be able to change plans for six months. The National Health Law Program (NHELP) has created an excellent brief explaining the essential protections necessary when passive enrollment is utilized.

We will report out further information on the duals coordinated care project in future blogs.

Resources:
National Health Law Program (NHELP) brief on passive enrollment protections
Families USA brief: State Demonstrations to Integrate Medicare and Medicaid
Federal Medicare-Medicaid Coordination Office