Expanding and Improving Integrated Care Options for Dual Eligibles in California

Oct 22

For more than 10 years, Aurrera Health has supported the California Department of Health Care Services (DHCS) in its commitment to creating more integrated health care options for individuals who receive both Medicaid and Medicare services. These individuals, often referred to as “dual eligibles,” include low-income seniors and individuals with disabilities who often have multiple complex health conditions. California, like other states, has been focused on advancing approaches to more effectively and efficiently care for this population and better manage Medicaid costs.

In 2011, Aurrera Health began supporting DHCS in the development and implementation of its Coordinated Care Initiative (CCI), which established managed long-term services and supports and launched Cal MediConnect (CMC) to coordinate the delivery of Medicare and Medicaid services for dual eligibles. CCI was implemented in seven counties across the state as part of a demonstration project in partnership with the federal government. Since CCI’s inception, Aurrera Health has worked with DHCS leadership to develop strategy, design and implement policy, engage stakeholders, and conduct outreach and education.

DHCS is currently building on successes and lessons learned from CCI to expand integrated care for dual eligibles statewide. Specifically, the state has transitioned from its CMC model to one that ensures aligned enrollment in integrated Medicare and Medicaid managed care plans (i.e., Medi-Cal Managed Care Plans and Medicare Advantage Dual Eligible Special Needs Plans) that are operated by the same health plan. We are supporting DHCS as it works to expand access to that model across the state, and ensure implementation is driving more coordinated care and better outcomes for participants. To help facilitate this work, Aurrera Health continues to support DHCS with strategy development, policy design and implementation, including development of policies related to enrollment, plan readiness, care coordination, quality metrics, and reporting, as well as stakeholder engagement, education, and outreach activities.