Category

DUAL DEMONSTRATIONS

Repeal of the ACA—Without a Replacement—Threatens California Seniors

By | Affordable Care Act, BLOG, DUAL DEMONSTRATIONS, DUAL ELIGIBLES, Health Care, Health Care Defense, HOMEPAGE, Medicaid, Medicare | No Comments
There are currently 7.6 million older adults living in California who rely on Medicare, Medi-Cal, and the Affordable Care Act (ACA) to see a doctor, receive care in their home, and pay for prescription drugs. The repeal of the ACA threatens these critical programs, jeopardizing the care seniors receive every day. Read More

Cal MediConnect: A Long Way to Go

By | Affordable Care Act, BLOG, DUAL DEMONSTRATIONS, DUAL ELIGIBLES, Health Care, HOMEPAGE, Medicaid, Medicare | No Comments
Evaluation and enrollment data on the Cal MediConnect program reveals that the program has a long way to go to deliver on the promise of integrated person-centered care. While the data contains some promising trends, it also reveals serious deficiencies that demand focused attention from the Centers for Medicare and Medicaid Services (CMS) and the Department of Health Care Services (DHCS).

The Cal MediConnect (CMC) program, which created new health plans integrating Medicare and Medi-Cal benefits for dually eligible beneficiaries, has been in effect for over two years in seven California counties. Enrollment data released by DHCS and a recent series of evaluations, including surveys, focus groups, and polling, paint a picture of how the program is performing and how enrollees are faring so far. Read More

Meeting the Mental Health Needs of Dual Eligibles: An Opportunity for Advocates

By | Alzheimer's & Dementia, BLOG, DUAL DEMONSTRATIONS, DUAL ELIGIBLES, Health Care, HOMEPAGE | No Comments
May is both Older Americans Month and Mental Health Awareness Month. Mental health is a critical issue for older Americans, as one in five seniors has a mental health issue, and older men have the highest suicide rate of any group, according to the CDC. The mental health needs of seniors and persons with disabilities who are dually eligible for Medicare and Medicaid are often overlooked in traditional medical settings, ramping up costs and leading to inadequate care. Read More

The Duals Demonstration: A First Glimpse at Lessons Learned

By | DUAL DEMONSTRATIONS, ISSUE BRIEF, Medicaid, Medicare | No Comments

In January 2016, the Centers for Medicare and Medicaid Services (CMS) released the first ever evaluation of the Financial Alignment Initiative (FAI) known as the dual eligible demonstration.

Since the first dual eligible demonstrations rolled out in August 2013, Justice in Aging has followed the process both through the advocates on the ground who counsel clients directly, through the plans we’ve worked closely with, and through our work directly with the state agencies that administer the demonstrations. As national experts on the issues facing dual eligibles we’ve been both an information hub for advocates and feedback loop for policymakers. As such, we’ve been awaiting the release of the first formal evaluations of the demonstrations to see if they match the information we’ve been receiving. They have been released and we’ve analyzed them and published an issue brief on the findings.

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WEBINAR: The California Coordinated Care Initiative: An Update Two Years into Implementation

By | CA Health Network Alert, DUAL DEMONSTRATIONS, DUAL ELIGIBLES, WEBINAR | No Comments
When: Thursday, February 18 at 2:00 p.m. PST/5:00 p.m. EST

California began implementation of the Coordinated Care Initiative (CCI), including the federally-approved dual eligible demonstration known as Cal MediConnect, in April 2014. The CCI is now underway in seven counties including Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara.

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Intersectional Advocacy in Health Care and Long-Term Services and Supports

By | BLOG, DUAL DEMONSTRATIONS, DUAL ELIGIBLES, Health Care, HOMEPAGE, Medicaid, Medicare | No Comments
Partnerships are at the heart of our work at Justice in Aging. I’m a staff attorney in Justice in Aging’s Los Angeles office. Much of my work focuses on disparities in access to quality, person-centered health care and services for California’s dual eligibles (the low-income, high-need demographic eligible for both Medicare and Medicaid). My day-to-day consists of training and education of advocates “on the ground,” providers, health plans, and policymakers and meeting with these folks regularly to share issues and synthesize solutions. This includes opportunities to participate in forums, plenaries, and tele-town hall meetings that advance advocacy for older adults on a local level by engaging multiple sectors of the community in the same room.

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The Dual Eligible Demonstrations at Five: Justice in Aging Toolkit on Design and Implementation

By | DUAL DEMONSTRATIONS, DUAL ELIGIBLES, ISSUE BRIEF, REPORTS | No Comments

States and CMS are in the early stages of evaluating the demonstrations and also looking at mid-course corrections and improvements based on experiences to-date. At the same time, advocates and policymakers are contemplating future health care delivery system reforms, as part of a broader reform effort to pay for value and outcomes, instead of volume.

To contribute to these efforts, Justice in Aging has created a toolkit of design and implementation resources. The toolkit consists of:

  • A new tool for advocates comparing different state outreach and enrollment materials to highlight effective models to use when reaching vulnerable populations. The new tool includes two appendices: Appendix 1, a working chart with links to outreach materials in different states. Appendix 2, accessible from the Outreach and Notices tab on this page, includes examples of notices currently in use in states, and our comments on strengths and areas of improvement.
  • Resources on appeals procedures, designing enrollment notices, care continuity, and ensuring consumer protections in integrated models. These resources were developed earlier by Justice in Aging to influence the demonstration’s design to ensure consumer protections were a focus of new managed care delivery systems. They are assembled together for the toolkit and linked from this page.

County Specific D-SNP Fact Sheets for Advocates

By | Alerts, DUAL DEMONSTRATIONS, DUAL ELIGIBLES, Health Care | No Comments

Dual Eligibles in a number of California counties who are currently enrolled in either Medicare Advantage Plans or certain Duals Special Needs Plans (D-SNPS) may see their plans change and/or may be subject to passive enrollment in Cal MediConnect, depending on a number of factors. The California Department of Health Care Services (DHCS) released the new Duals Special Needs Plan (D-SNP) policy last summer for beneficiaries in Los Angeles, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara Counties, and more recently for Orange County.

To help advocates unravel the complex policy and better advise their clients, Justice in Aging developed a series of county-specific fact sheets summarizing for advocates how beneficiaries are impacted depending on the type of Medicare Advantage plan in which a beneficiary is enrolled.

Today, we are releasing the Orange County fact sheet for the first time, and rereleasing the other county-specific fact sheets.

Orange County
Los Angeles County
Riverside County
San Bernardino County
San Diego County
San Mateo County
Santa Clara County

County-Specific D-SNP Fact Sheets for Advocates

By | DUAL DEMONSTRATIONS, DUAL ELIGIBLES, FACT SHEET, REPORTS | No Comments

Dual Eligibles in a number of California counties who are currently enrolled in either Medicare Advantage Plans or certain Duals Special Needs Plans (D-SNPS) may see their plans change and/or may be subject to passive enrollment in Cal MediConnect, depending on a number of factors. The California Department of Health Care Services (DHCS) released the new Duals Special Needs Plan (D-SNP) policy last summer for beneficiaries in Los Angeles, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara Counties, and more recently for Orange County.

To help advocates unravel the complex policy and better advise their clients, Justice in Aging developed a series of county-specific fact sheets summarizing for advocates how beneficiaries are impacted depending on the type of Medicare Advantage plan in which a beneficiary is enrolled.

Today, we are releasing the Orange County fact sheet for the first time, and rereleasing the other county-specific fact sheets.

Orange County
Los Angeles County
Riverside County
San Bernardino County
San Diego County
San Mateo County
Santa Clara County

Please visit the Duals Demonstration Advocacy website for additional resources on the CCI.