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CMA opposes expansion of dual eligible managed care pilot program

Governor Jerry Brown continues to push to move all “dual eligibles” – patients covered through both Medi-Cal and Medicare – into managed care. In his revised budget plan, the Governor proposes expanding the four-county pilot project to include eight counties. The California Medical Association (CMA) believes the pilot project as currently defined will lead to disruptions in care for the state's neediest and sickest patients. The project, authorized by the Legislature in 2010 (SB 208), is set to begin in early 2013. The initial four counties selected by the California Department of Health Care Services – Los Angeles, Orange, San Diego and San Mateo counties – contain almost half of all of the dual eligibles in California. CMA believes this can no longer be called a pilot project, and is urging the Legislature to reject the Governor's proposal to expand the project. Beyond our concerns about the size and scope of the pilot, CMA has also requested a number of changes to the project. "It is clear that the administration is moving forward with this drastic expansion of managed care in pursuit of significant budget savings, with potentially injurious impact to patients," CMA wrote in a letter to legislators. To mitigate disruptions in care, CMA has requested, among other things: Meaningful patient and physician protections that cannot be negotiated away Provider reimbursement at or above Medicare levels Ability for patients to opt out of the program and to change plans if they were auto-assigned That participating plans be required to use the most current billing, diagnostic coding and editing procedures The Governor's proposed budget also continues the plan to transition all Healthy Families children into Medi-Cal managed care. CMA is working with the legislature and the administration on alternatives that will protect physicians and patients. Thanks to CMA's legal and legislative advocacy efforts, the Governor's revised budget proposal doesn't include Medi-Cal payment cuts, despite numerous recent attempts to slash the state's already low provider rates. Most recently, a federal court judge in February issued a final order enjoining the state of California from implementing a 10 percent cut to Medi-Cal reimbursement rates. Between this upcoming budget year and the last, CMA's legal advocacy has prevented more than $420 million in provider rate cuts. Also in February, the Centers for Medicare & Medicaid Services rejected California’s request to impose mandatory copayments for Medi-Cal patients, which would have saved the state $511 million.


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