Aiming for Integrated Care for Dual Eligible Individuals

Under the California Advancing and Innovating Medi-Cal (CalAIM) initiative, the state’s Department of Health Care Services (DHCS) has once again renewed its decades-long commitment to creating more integrated health care options for individuals who receive both Medi-Cal and Medicare coverage. These “dual eligible” individuals are a diverse population – they often have multiple chronic conditions such as physical, behavioral, and cognitive impairments, and are more likely to have limited English proficiency and low health literacy. As such, California’s dual eligibles have benefitted significantly from programs designed to better coordinate and integrate their care over the past decade.

Background

Aurrera Health Group began supporting DHCS in 2012 to develop, launch, and implement the Coordinated Care Initiative, which created Managed Long-Term Services and Supports (MLTSS) and integrated health plans – called Cal MediConnect (CMC) plans – under a Section 1115 waiver authority known as the Medicare-Medicaid federal financial alignment demonstration. Building on the successes and lessons learned from the initiative, the state is updating and expanding an integrated care model statewide. As such, our work with DHCS is shifting focus to developing the new integrated care model and to supporting the transition of California’s dual eligible beneficiaries to a new framework under CalAIM.Over the next several years, DHCS will transition its integrated care options for dual eligible beneficiaries to an exclusively aligned enrollment Medicare Advantage (MA) Dual Eligible Special Needs Plan (D-SNP) and MLTSS structure. The intent is to maintain focus on person-centered care and integration across Medicare and Medi-Cal by aligning D-SNP and Medi-Cal Managed Care Plans (MCPs) to be operated by the same parent health plan. The transition to matching D-SNP and MCP products in 2023 in CCI counties will enable current CMC members to stay with the same parent plan in which they are currently enrolled if they wish.

Developing Policy and Engaging Stakeholders

To encourage stakeholder participation in policymaking and to benefit from promising practices and lessons learned from CCI, the Aurrera Health Group team is working with DHCS to host monthly MLTSS and Duals Integration Stakeholder workgroup meetings. The meetings have covered topics including:

• Best practices from CMC in care coordination and serving populations of focus such as individuals with dementia;

• Connections to services carved out of Medi-Cal managed care benefits (including Behavioral Health and LTSS); and

• Leveraging CMC and CCI outreach strategies to beneficiaries and providers.

During these meetings, Aurrera Health Group incorporated a series of breakout sessions to engage additional stakeholder participation and solicit more detailed feedback on proposed policies.

Future Work

We look forward to another year of exciting and challenging work on behalf of California’s dual eligible beneficiaries. We will continue to host the monthly MLTSS and Duals Stakeholder Workgroups, convene monthly health plan workgroup meetings, and facilitate monthly technical assistance sessions as well as continue our support of policy development to improve outcomes for dual eligible individuals throughout California.

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Authors

Sasha Hulsey [Deputy Director]

Alisa Chester [Director]