Late News: California gets approval for CMS demonstration project

California became the fifth state—and by far the largest—to win approval of a CMS demonstration project that will put beneficiaries dually eligible for Medicare and Medicaid into managed-care plans. The agreement between the California Department of Health Care Services and the CMS will provide a single, capitated monthly payment for providing services for about 456,000 dual-eligible enrollees, beginning in October. While that figure is significant, it’s about half as much as Democratic Gov. Jerry Brown requested in early 2012. The CMS drew heavy criticism last year for the scope and pace of the program, which stems from the Patient Protection and Affordable Care Act and seeks to find a way to rein in costs for a disproportionately expensive population of patients. Dual eligibles are among the highest-cost users of healthcare services in California’s Medicaid program, Medi-Cal, accounting for 25% of its spending, according to DHCS. California appears more aggressive in its implementation of its program, known as Cal MediConnect, compared with the other four states—Illinois, Ohio, Massachusetts and Washington—that have also signed agreements with the CMS for the pilots. California, for example, will start with passive enrollment, meaning dual eligibles will automatically get transferred into the program. Illinois, in contrast, will start with voluntary enrollment in October, followed by passive enrollment in January 2014. “The agreement between DHCS and CMS reveals that significant work remains to be done to ensure that low-income older adults and persons with disabilities will be protected,” Kevin Prindiville, deputy director of the National Senior Citizens Law Center, said in a statement.