Dedicated to Integrating Systems of Care for Dual Eligibles in California for Over 10 Years

For many of us, navigating two complicated health care systems – Medicare and Medicaid – is personal. We have struggled to help family and friends access critical care. This experience is a reminder of why Medicare-Medicaid integration is an urgent priority for state and federal decision makers. And it is why Aurrera Health takes pride in our continuous support of the California Department of Health Care Services (DHCS) since 2011, working to improve care for individuals dually eligible for Medicare and Medicaid. Recently, Aurrera Health has been focused on the transition of dual eligible members from Cal MediConnect Financial Alignment Initiative (FAI) plans to Exclusively Aligned Enrollment Dual Eligible Special Needs Plans (EAE D-SNPs). In 2023, DHCS transitioned coverage of dual eligible individuals in a Cal MediConnect Plan to EAE D-SNPs of the same parent company, which provide dual eligible individuals both their Medicare and Medi-Cal benefits. Our team’s deep subject matter expertise on all aspects of how states can bolster integrated care options for dual eligible individuals, and provide high-quality, person-centered, equitable care to this population has helped to make this transition a success. Aurrera Health’s work in California centers on policy development, stakeholder engagement, and technical assistance.  

Policy Development 

Part of the challenge of providing care to dual eligible individuals is the siloed structure of care paid for by Medicare and Medicaid. In partnership with DHCS and the Centers for Medicare & Medicaid Services (CMS) Medicare-Medicaid Coordination Office (MMCO), our team supported the development of policies for dual eligible individuals that align with both Medicare and Medi-Cal rules and regulations, based on best practices learned from the Coordinated Care Initiative. Aurrera Health drafted policies regarding enrollment, plan readiness, care coordination, and models of care. We also provided insight on the development of quality metrics and reporting requirements to support the transition of dual eligible members who were enrolled in a Cal MediConnect plan to an integrated D-SNP product.  Aurrera Health provides clients with a strategy for building and implementing a framework of care centered on integration. This includes the development of policy documents such as the D-SNP State Medicaid Agency Contract (SMAC), D-SNP Policy Guide, and supplemental materials. For example, Aurrera Health worked with DHCS on integrated federal care coordination requirements for D-SNPs as outlined in the D-SNP Model of Care with state care coordination requirements for Medi-Cal, including carved-out services, Enhanced Care Management, and palliative care. Based on successful programs in Cal MediConnect plans, Aurrera Health also ensured the inclusion of trained dementia care specialists to help provide care for member’s living with dementia.  

Stakeholder Engagement 

A vital component of our work in California is conducting stakeholder engagement, provider outreach, and implementing communication strategies. These efforts aim to inform diverse groups of stakeholders about the transition and opportunities to better integrate care and solicit input to develop stakeholder-informed policies. Our recently released Health Affairs blog, Building Trust for Change: Lessons on Stakeholder Engagement from California’s Integrated Care Models, shares best practices for states to consider as they develop integrated models of care, particularly for states transitioning FAI populations.   

Technical Assistance 

We leverage our policy and communications experience to ensure that DHCS is responsive to advocates, beneficiaries, plans, state agencies, and others on complex implementation needs and inquiries. Our work in California has included:  

• Supporting operational implementation of integrated care policies for dually eligible individuals, including establishing channels to support health plans operationalization of state guidance.  

• Providing analysis and strategic advice on integrated care model options, including assessment of peer states.  

• Facilitating stakeholder outreach and developing targeted communications materials.  

• Offering a landscape analysis of existing Medicare and Medicaid products in the state.   

• Providing an analysis of potential challenges to integrated care in the state.  

• General project management support, including facilitation of internal and external meetings, developing workplans and timelines, answering questions from stakeholders, managing shared document systems, and identifying roles and responsibilities for staff and state agencies.   

Looking Ahead 

We are excited to continue the work of improving integrated systems of care for dual eligibles in California, particularly as DHCS continues to implement policies to increase access to D-SNPs across the state. After supporting DHCS through this complex transition, our team is uniquely positioned to help other states develop strategies to integrate care for dual eligible members and leverage policy opportunities to serve their Medicare population.  To learn more about Aurrera Health’s work on Medicare-Medicaid integration in California, or to discuss our capabilities to support your state in similar initiatives, please reach out to our team.   

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Authors

Mary Russell [Principal]

Kristal Vardaman [Managing Principal]

Alisa Chester [Director]