« The Dual Agenda: October 16, 2014 Issue



L.A. Care, a health plan in California, announced that it will start accepting passive enrollment into the Cal MediConnect program in January 2015. L.A. Care was barred, under CMS guidance rules, from accepting passive enrollment when Cal MediConnect launched earlier this year, due to having received a “low-performing icon” based on its Medicare quality ratings. Given an improvement in its star rating, L.A. Care has now been approved to accept passive enrollment in 2015.   

In other news, the California Department of Health Care Services will hold a webinar offering a stakeholder update on the Coordinated Care Initiative (CCI) on October 21. The CCI includes both the Cal MediConnect demonstration and Managed Medi-Cal Long-Term Supports and Services. The latter applies to all California Medicaid beneficiaries. The upcoming call will cover January 2015 CCI enrollment and the new funding for the Cal MediConnect Ombudsman program.


The Medicare-Medicaid Coordination Office (MMCO) posted on their website a frequently asked questions guide for providers interested in learning more about the Illinois Medicare-Medicaid Alignment Initiative (MMAI) Continuity of Care provisions.


Team members of the Michigan Voices for Better Health project presented at two senior living facilities on the basics of the state’s dual eligible demonstration project, MI Health Link. The first presentation was on September 29 in Detroit and the second on September 30 in Clinton Township. The presentation and discussion covered considerations for joining the program or opting out, picking a health plan and the opportunities for consumers to be involved in the implementation process.


Two new blog posts from UHCAN Ohio for the Ohio Consumer Voices for Integrated Care (OCVIC) coalition, highlight the continuing problems faced by consumers enrolled in MyCare Ohio. The first post, by John Arnold of UHCAN, Project Manager for OCVIC, reports on a consumer conference call hosted by OCVIC, on which enrollees expressed concerns about critical lapses in the program affecting their care, such as their independent providers not getting paid for months, or not getting authorization in time for their prescription drugs. These serious issues in the early months of MyCare Ohio have reached local media, as well. A recent article in The Columbus Dispatch further explains the issues independent providers are still facing and the resulting hardships on consumers and their care.

The second post, by UHCAN Ohio Executive Director, Cathy Levine, reinforces the continued problems around MyCare Ohio’s launch and issues a call to delay passive enrollment on the Medicare side of the demonstration. With a number of systemic issues not yet resolved, the OCVIC coalition, led by UHCAN Ohio, calls to “postpone a few months” the planned January 1, 2015 start, to address problems. Once Medicare-side passive enrollment does begin, the advocates call for it to be phased in gradually, to allow for plans, the state and CMS to have the time to fix new glitches as they surface.

Rhode Island

The Voices for Better Health team of advocates in Rhode Island developed a great fact sheet explaining the choices that consumers have under the Integrated Care Initiative, the state’s effort to improve the care and quality of life of Rhode Island dual eligibles. Rhode Island is pursuing its Integrated Care Initiative in two phases. Phase One focuses on managing Medicaid long-term services and supports (LTSS) and improving the coordination of primary care, behavioral health services and home and community-based services. Phase One services are available for dually eligible beneficiaries, as well as Medicaid beneficiaries receiving LTSS. Phase Two will be focused on moving to full integration of Medicaid and Medicare services for dually eligible beneficiaries delivered by a single capitated health plan.

In other news, Rhode Island hosted its monthly Integrated Care Initiative Consumer Advisory Council on October 1, sharing key updates related to the development of the demonstration project. Key information presented at the meeting:

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