A Lot of Low-Income Disabled Seniors Reject Shift to Managed Care

Friday, November 28, 2014

Low-income disabled seniors are dodging state efforts to redirect 500,000 Californians who use both Medi-Cal and Medicare into a single, managed-care program.

As of October 1, 44% of the 195,000 targeted seniors in seven counties had opted out of the Cal MediConnect pilot project, according to the California Department of Public Health (CDPH). They refused to trade a struggle with two giant bureaucracies for a single new one, while often giving up access to their doctors, flexibility and familiar settings.

Anna Gorman, who wrote about the program in the past at the Los Angeles Times and more recently at Kaiser Health News, characterized the six-month effort as being plagued by “widespread confusion, frustration and resistance.” The CDPH received 50,000 phone calls for help.

The Los Angeles County Medical Association and a coalition of plaintiffs unsuccessfully sued in Sacramento County Superior Court to halt the program. They were denied a preliminary injunction in August. Dr. William Averill, an association executive board member, told Gorman, “We are concerned that [the project] is ill-conceived, ill-designed and will jeopardize the health of many of the state’s most vulnerable population—the poor, the elderly and the disabled.”

MediConnect was pushed by the federal government as part of the Affordable Care Act to save money and streamline care. Medicare is the federal program that pays for most doctor visits and trips to the hospital, while Medi-Cal, which is California’s version of Medicaid, covers nursing and long-term care.

Critics say the streamlining includes a reduction in care by shunting the so-called “dual              eligibles,” with their compound needs, into a system with fewer resources. Most will lose some continuity in care and access to some services as they are shifted to different providers.

California is one of about 20 states to accept the federal government’s largesse in funding this consolidation and is the most aggressive in implementing it. The three-year pilot program, authorized in July 2012, is designed to move about half of the state’s 1.1 million dual eligibles.

Los Angeles County has 374,000 dual eligibles, by far the most in the state, and dominates the first round. They were sent notices in June that they would get a case manager to coordinate their health care, and the payment system would be run through the health plan.

If the old, sick people didn’t respond to the mailing, they would automatically be enrolled.  

–Ken Broder


To Learn More:

California’s Managed Care Project for Poor Seniors Faces Backlash (by Anna Gorman, Kaiser Health News)

One-Quarter of Possible Participants Have Opted Out of the Duals Project (by David Gorn, Healthline)

Filipino Americans Dismayed over Cal MediConnect (by Christian Esteban, Asian Journal)

Temporary Injunction in Cal MediConnect Case Denied (California Medical Association)

Los Angeles County Doctors Sue State over Cal MediConnect Program (by Susan Abram, Los Angeles Daily News)

Low-Income California Seniors to Move into New Managed Care Plan (by Anna Gorman, Los Angeles Times)

Smooth Landing?: How California Can Ensure Continuity of Care for Vulnerable Seniors

Transitioning to Managed Care (by Kathryn G. Kietzman, Jacqueline M. Torres, Charlene Chang, Tina Duyen Tran and Steven P. Wallace, UCLA Center for Health Policy Research) (pdf)

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