New CHCF Report Highlights Benefits of Aligned 'Medicare Medi-Cal Plans' for Dual-Eligibility Enrollees - State of Reform

New CHCF Report Highlights Benefits of Aligned ‘Medicare Medi-Cal Plans’ for Dual-Eligibility Enrollees – State of Reform

As part of the statewide CalAIM initiative, dual Medicare and Medi-Cal enrollees will soon be able to enroll in Medicare Medi-Cal Plans (MMPs) to improve coordination across all Medicare benefits and Medi-Cal and make it easier for those Californians with dual eligibility. to navigate through both systems.

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MMPs are Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) that are “aligned” with a Medi-Cal plan from the same parent organization. According to a new report from the California Health Care Foundation (CHCF), the intention of MMPs is to provide “…comprehensive care management, simplified member notification documents, a single insurance card for both plans, directories of providers and single prescription forms, and a unified complaints and appeals process.”

CHCF says aligned MMPs can reduce duplication and confusion in care coordination, prevent delays in receiving durable medical equipment, make enrollees eligible for certain non-medical supports to meet social needs, and improve outcomes. and satisfaction with care.

“A study comparing the outcomes of people with dual eligibility in integrated models to people in regular and non-aligned MA plans found that many of the more integrated models were associated with increased HCBS and less institutionalization,” indicates the report.

The report recommends several strategies and considerations for implementing MMPs in California. To address potential financial challenges, the report recommends that MMPs improve their quality scores to increase reimbursement, accurately assess the care needs of MMP enrollees to ensure appropriate reimbursement for people with complex needs, secure additional funding to support the early years of implementation and are preparing to offer support to Medi-Cal plans developing Medicare products for the first time.

To support Medi-Cal plans developing first-time Medicare products, the report also recommends that the state conduct focus group listening sessions with dual-eligible Californians to learn what would help them choose MMPs. and to increase Medicare expertise in Medi-Cal organizations.

To support provider network development and strong enrollment, the report recommends encouraging providers to join the network by increasing payments to providers, as well as targeting provider outreach using data on current service providers. Medicare paying.

According to the CHCF, state MMPs should focus on developing strategies to incentivize members to actively select their MMP in order to remain financially viable, including developing targeted outreach and marketing strategies to help people understand the benefits of integrated care.

According to CHCF, the Department of Health Care Services (DHCS) should work with state partners such as the Department of Aging and the Department of Insurance to ensure local awareness and engagement with the counseling and counseling program. health insurance advocacy, health insurance agents and Medicare brokers. .

The report says the state should also focus on better engaging historically marginalized groups and Californians who face language barriers by developing resources that can facilitate enrollment processes and center equity, and by actively monitoring inequalities in service use and outcomes.

In January 2023, Medi-Cal managed care plans in all 7 Coordinated Care Initiative (CCI) counties will establish MMPs and transition members of Cal MediConnect plans to them. All other Medi-Cal managed care plans in the state are expected to develop MMPs by January 2026.

The CHCF highlighted the potential benefits of the MMP model.

“As the state rolls out this new model, stakeholders should prioritize clearly communicating the benefits of an aligned approach to Californians and their dual-eligible providers, monitoring the operation of these new plans, and evaluating the impacts on enrollee experiences and whether aligned MMPs improve outcomes and address disparities,” the report states.


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