California Coordinated Care Initiative: What Self-Advocates and Families Need to Know

California Coordinated Care Initiative: What Self-Advocates and Families Need to Know

By Amber Cutler & Michelle Rojas Soto February 12, 2015

Structure and Logistics

Take notes Type your questions

Download slides

Watch and Share

Take Survey

During the Webinar

After the Webinar

Give your opinion

Poll: Can you hear Amber and Michelle?

Let us know in the chat box if we need to speak louder.

About Michelle Rojas Soto Moderator USC UCEDD Director of Community Education, Information Dissemination and Technical Assistance [email protected] www.uscucedd.org

The USC University Center of Excellence in Developmental Disabilities at Children’s Hospital Los Angeles (USC UCEDD) is one of 67 centers around the country. Our mission is to provide leadership in strengthening family-centered, culturally-competent services and systems for the benefit of individuals with, or at risk for, developmental, behavioral and/or special health care needs and their families in partnership with those who utilize the services.

About Amber Cutler Presenter Staff Attorney National Senior Citizens Law Center [email protected] http://www.nsclc.org

The National Senior Citizens Law Center is a non-profit organization whose principal mission is to protect the rights of low-income older adults. Through advocacy, litigation and the education and counseling of local advocates, we seek to ensure the health and economic security of those with limited income and resources, and access to the courts for all.

Glossary • Coordinated Care Initiative (CCI)

– Cal MediConnect

• Dual Eligible (Dual)

• Duals-Special Needs Plan (D-SNP)

• Fee-for-Service (FFS)

• Long Term Services and Supports (LTSS) – In-Home Supportive Services (IHSS), Community Based Adult

Services (CBAS), Multipurpose Senior Services Program (MSSP), Nursing Facility

• Medi-Cal Managed Care

• Program of All-Inclusive Care for the Elderly (PACE)

• Seniors and Persons with Disabilities (SPDs)

6

CCI = three big changes

7

CCI Change Description

Mandatory Medi-Cal Managed Care

Duals and previously excluded SPDs must enroll in Medi-Cal Managed Care

LTSS Integration LTSS added to Medi-Cal Managed Care plan benefit package

Medicare Integration (Cal MediConnect)

For duals, integration of Medicare and Medi-Cal benefits into one managed care plan.

The current Medi-Cal, LTSS, and Medicare delivery systems are different

Medi-Cal (medical services)

Medi-Cal (LTSS services)

Medicare

Managed care

Managed care

FFS FFS FFS

(default)

OR OR

*Behavioral Health

Current System

8

CCI moves services into managed care

Medi-Cal (medical services)

Medi-Cal (LTSS services)

Medicare

Managed Care

New System

*Behavioral Health

9

Managed Care: Plans paid to provide covered services via network providers

10

Senior/Person with Disability

Provider

DHCS & Medicare

Provider Provider

$$

Health Plan DHCS &

Medicare

$$

Medi-Cal and Medicare

(Dual Eligibles)

Medi-Cal only (SPDs)

Medicare Only

Impacted Not

Impacted

CCI impacts duals & seniors and persons with disabilities with Medi-Cal

11

Different groups of DUALS and SPDs are affected differently

12

Medi-Cal Only (SPDs)

• Nursing Facility

Residents • Share of Cost

Medical Exemption Request (MER) Available

Duals Not CMC Eligible

• Regional Center

Clients • ESRD Diagnosis • In Waivers STILL HAVE TO CHOOSE

A MEDI-CAL plan

Duals Who Won’t Get

CMC Notices

•In certain Medicare plans •In Kaiser STILL HAVE TO CHOOSE

A MEDI-CAL plan

Exceptions: Duals and SPDs who reside in an ICF/DD, Veteran’s Home, or who have Other Health Coverage do not have to join a plan.

Total Impact: 1,125,000

13

County Duals Subject to Passive Enrollment in Cal MediConnect

Medi-Cal MC Only

Alameda 32,533 48,000

Los Angeles 288,399 (200,000 cap) 317,000

Orange* 65,537 51,000

Riverside 40,040 46,000

San Bernardino 41, 930 54,000

San Diego 55,798 64,000

San Mateo 12 371 14,000

Santa Clara 37, 739 38,000

Totals 574, 347 ( 485,948 with cap) 632,000

Regional Center Clients Still Have to Choose a Medi-Cal Plan

14

Regional Center Client

Medi-Cal

Passive Enrollment

www.NSCLC.org 15

Enroll

Dual

Choose a Medi-Cal Plan

Do Nothing Enrolled into

Medi-Cal Plan

What is the Medi-Cal Plan Responsible For if You’re a Dual

16

• The Medi-Cal plan is responsible for benefits Medicare does not pay for: • Long-Term Services and Supports – In-Home Supportive Services ,

MSSP, CBAS, and Nursing Facility Care • Medi-Cal transportation services • Durable Medical Equipment • Certain Prescription Drugs • Medi-Cal Supplies

• The Medi-Cal Plan Pays the Medicare Provider the 20% Co-Insurance

• The Medicare provider DOES NOT have to be contracted with the Medi-Cal plan to bill the plan for the 20% co-insurance

Los Angeles Medi-Cal Plans

17

• LA Care

– Plan Partners

• Anthem Blue Cross

• Care 1st

• Kaiser

• Health Net

– Plan Partner

• Molina

CCI will be implemented in 7 counties

Alameda Los Angeles

Orange Riverside

San Bernardino San Diego San Mateo Santa Clara

18

Timeline – Los Angeles County

19

• Most Duals who only have to choose a Medi-Cal plan do so by birth month (August 2014 Start Date)

• Duals in Medicare Advantage Plans have to choose a Medi-Cal plan (January 2015 start date)*

• SPDs not already in a Medi-Cal plan choose one by birth month (August 2014 start date)

*July – January in January, then by birth month

Most beneficiaries will receive three notices

90 Day 60 Day 30 Day ENROLLMENT

6/1/14

10/1/14

7/1/14

11/1/14

8/1/14

12/1/14

ENROLLMENT 9/1/14

ENROLLMENT 1/1/15

September DOB

January

20

www.NSCLC.org 21

90 Day

60 Day

30 Day

• Informational Notice

• Notice with Default Plan • Guidebook • Choice Booklet and Choice Form

• Final Reminder Notice

When

22

90-Day Medi-Cal Managed Care Notice

23

60-Day Medi-Cal Managed Care Notice

24

90-Day Cal MediConnect Notice

25

60-Day Cal MediConnect Notice

What can you do?

• Influence program development

– Stakeholder meetings

– Talk to plan

– Legislative advocacy

• Prepare to provide counsel

• Report problems

26

Local advocates can help individuals

• HICAP

1-800-434-0222

• CCI Ombudsman

1-855-501-3077

27

Want to know more? • NSCLC Duals Website

– Advocate’s Guide

– News

– Sign up for alerts

http://dualsdemoadvocacy.org

• Contact us:

– Amber Cutler – [email protected]

– Denny Chan – [email protected]

Wrap Up

28

• Disability Rights Education & Defense Fund (DREDF)

- www.dredf.org

• Department of Healthcare Services

- www.calduals.org

Poll: Do you have a better understanding of CCI and how it affects you now?

Ask Me a Question

Please type your questions (Top-left corner of your MeetingBurner screen)

Thank you for attending and interacting!!

www.slideshare.net www.youtube.com

Webinar Evaluation Survey

You have access to webinar slides, handouts and video recording.

Don’t leave yet!! Please take 3 minutes to answer a survey about your experience with this webinar