SFMS/CMA Oppose Expansion of Dual Eligible Managed Care Pilot Program June 4, 2012 Advocacy, CMA, Medi Cal, Medicare dual eligible, Medicare/Medi-Cal, SB 208 0 Governor Jerry Brown continues to push to move all “dual eligibles”—patients covered through both Medi-Cal and Medicare—into managed care. In his revised budget plan, the Governor proposes expanding the four-county pilot project to include eight counties. SFMS and CMA believe the pilot project as currently defined will lead to disruptions in care for the state’s neediest and sickest patients. The project, authorized by the Legislature in 2010 (SB 208), is set to begin in early 2013. The initial four counties selected by the California Department of Health Care Services—Los Angeles, Orange, San Diego and San Mateo counties—contain almost half of all of the dual eligibles in California. SFMS and CMA believe this can no longer be called a pilot project, and are urging the Legislature to reject the Governor’s proposal to expand the project. To mitigate disruptions in care, CMA has requested, among other things: Meaningful patient and physician protections that cannot be negotiated away Provider reimbursement at or above Medicare levels Ability for patients to opt out of the program and to change plans if they were auto-assigned That participating plans be required to use the most current billing, diagnostic coding and editing procedures The Governor’s proposed budget also continues the plan to transition all Healthy Families children into Medi-Cal managed care. SFMS/CMA are working with the legislature and the administration on alternatives that will protect physicians and patients. Thanks to our legal and legislative advocacy efforts, the Governor’s revised budget proposal doesn’t include Medi-Cal payment cuts, despite numerous recent attempts to slash the state’s already low provider rates. Most recently, a federal court judge in February issued a final order enjoining the state of California from implementing a 10% cut to Medi-Cal reimbursement rates. Between this upcoming budget year and the last, CMA’s legal advocacy has prevented more than $420 million in provider rate cuts. For more details on the governor's revised budget as it relates to health care, see CMA’s Budget Summary. Below: The division of responsibilities between Medicare and Medi-Cal. Comments are closed.
