DHCS Suspends Planned Passive Enrollment for Duals Project


The Department of Health Care Services (DHCS) has announced that it would not move forward with its planned annual passive enrollment of dual eligible beneficiaries under the Coordinated Care Initiative (CCI) after it received feedback from the California Podiatric Medical Association (CPMA), the California Medical Association (CMA) and more than 40 other stakeholders asking the agency to pursue enrollment strategies that support voluntary "opt-in" enrollment.

Instead, DHCS said it will implement a voluntary "opt-in" enrollment effort beginning in July 2016. The new streamlined enrollment strategy will include mandatory Managed Medi-Cal Long-Term Supports and Services (MLTSS) plan enrollment. DHCS said it would monitor participation in the program; should voluntary enrollment not prove to be a viable option for program sustainability, passive enrollment remains an option in the future.

In April, DHCS released a series of proposals that would have changed the CCI enrollment process to 1) passively enroll beneficiaries into Cal MediConnect; and to 2) streamline enrollment by allowing plans to eliminate or dramatically reduce the role of the enrollment broker.

CPMA strongly opposed the proposals, noting that according an RIT International report that was commissioned by the Centers for Medicaid and Medicare Services, researchers found that states:

  • Faced conflicting Medicare and Medicaid policies concerning eligibility criteria and enrollment;
  • Had to manage a large influx of enrollees at one time;
  • Had staff "spen[d] an inordinate amount of time trying to locate enrollees in order to complete initial health assessments and introduce enrollees to the benefits of the demonstration;" and
  • Were surprised by the cost of adapting their technology systems to implement the demonstration programs.

Overall, the researchers reported that "addressing the nuts and bolts of aligning the Medicare and Medicaid program policies, procedures, and systems has been more time-consuming than [states] expected."

They added, "It is unclear at this point whether the time and resource commitments will diminish ... or if these efforts are inherent to coordinating Medicare, a national standardized program, with Medicaid, a State-specific program with unique features."

The Coordinated Care Initiative was authorized by the state in July 2012 in an effort to save money and better coordinate care for the state's low-income seniors and persons with disabilities. The program began with a three-year demonstration project that expected to see a large portion of the state's dual eligible beneficiaries transition to managed care plans.

Although the state is not going forward with passive enrollment in 2016, DHCS has stated they are still considering a passive enrollment strategy for 2017.