As part of the statewide CalAIM initiative, Medicare and Medi-Cal dual enrollees will soon be able to enroll in Medicare Medi-Cal Plans (MMPs) to improve coordination across all Medicare and Medi-Cal benefits and make it easier for these dually eligible Californians to navigate 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 intent of MMPs is to provide “… comprehensive care management, streamlined member notification materials, a single insurance card for both plans, single provider directories and prescription formularies, and a unified grievances and appeals process.”
CHCF says aligned MMPs can reduce duplication and confusion in care coordination, prevent delays in the receiving of durable medical equipment, make enrollees eligible for certain non-medical supports to address social needs, and improve outcomes and satisfaction of care.
“A study comparing outcomes for dually eligible people in integrated models to people in regular, nonaligned MA plans found that many of the more integrated models were associated with an increase in HCBS and less institutionalization,” the report states.
The report recommends several strategies and considerations for implementation of MMPs in California. To address potential financial challenges, the report recommends that MMPs improve their quality scores to increase reimbursement, accurately assess MMP enrollee care needs to ensure appropriate reimbursement for those with complex needs, secure additional funds to support the first few years of implementation, and prepare to offer support for Medi-Cal plans developing Medicare products for the first time.
In order to support Medi-Cal plans developing Medicare products for the first time, the report also recommends that the state conduct focus group listening sessions with dually eligible Californians to learn what would help them choose MMPs and increase Medicare expertise at Medi-Cal organizations.
To support provider network development and robust enrollment, the report recommends encouraging providers to join the network by increasing payments to providers, as well as targeting outreach to providers by using data on current fee-for-service Medicare providers.
CHCF says MMPs in the state should focus on developing strategies to attract members to actively select their MMP in order to stay 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 Department of Insurance to ensure local outreach and engagement with the Health Insurance Counseling and Advocacy Program, health insurance agents, and Medicare brokers.
The report says that the state should also focus on better engaging historically marginalized groups and Californians facing language barriers by developing resources that can aid enrollment processes and center equity, and actively monitoring inequities in service use and outcomes.
In January 2023, Medi-Cal managed care plans in the 7 Coordinated Care Initiative (CCI) counties will establish MMPs and will transition members of Cal MediConnect plans into them. All other Medi-Cal managed care plans in the state are expected to develop MMPs by January 2026.
CHCF emphasized 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 dually eligible Californians and their providers, monitoring how these new plans operate, and evaluating the impacts on enrollees’ experiences and whether aligned MMPs improve outcomes and address disparities,” the report states.
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