As part of the state’s 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 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-SNP) 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, simplified notification materials for members, a single insurance card for both plans, single directories of providers and 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 address social needs, and improve care outcomes and satisfaction.
“A study comparing outcomes for dually eligible people in integrated models to people in regular non-aligned MA plans found that many of the more integrated models were associated with increased HCBS and less institutionalization,” says the report
The report recommends several strategies and considerations for implementing MMP 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 adequate reimbursement for those with complex needs, secure additional funds to support the first years of implementation, and prepare to offer support for Medi-Cal plans that develop Medicare products for the first time.
To support Medi-Cal plans that develop Medicare products for the first time, 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 increase l ‘Medicare expertise in Medi-Cal organizations.
To support provider network development and robust enrollment, the report recommends encouraging providers to join the network by increasing provider payments, as well as targeting provider outreach using provider data of current Medicare.
CHCF says that MMPs in the state should focus on developing strategies to attract members to actively select their MMP to be financially viable, including developing marketing and marketing strategies to help people understand the benefits of integrated assistance.
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 outreach and engagement with the Program of 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 addressing language barriers by developing resources that can help center enrollment and equity processes, and actively monitoring inequities in the use of the service and results.
In January 2023, Medi-Cal managed care plans in the 7 Coordinated Care Initiative (CCI) counties will establish MMPs and transfer Cal MediConnect plan members to them. All other Medi-Cal managed care plans in the state are expected to develop MMP by January 2026.
CHCF emphasized the potential benefits of the MMP model.
“When the state launches this new model, stakeholders must 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 experiences of enrollees and whether aligned MMPs improve outcomes. and address disparities,” the report says.