As part of the statewide CalAIM initiative, Medicare and Medi-Cal dual-enrolees will soon be able to enroll in Medicare Medi-Cal Plans (MMPs) to improve coordination between all Medicare and Medi-Cal benefits and increase the make it easier for these dual-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 of the California Health Care Foundation (CHCF), the intent of MMPs is to “…provide comprehensive care management, streamlined reporting materials for members, a single insurance card for both plans, a single provider guide 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 meet social needs, and improve outcomes and satisfaction of care can be improved.
“A study comparing outcomes for dual-eligible people in integrated models with people in regular, non-aligned MA plans found that many of the more integrated models were associated with an increase in HCBS and less institutionalization,” states 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 health care needs of MMP enrollees to ensure appropriate reimbursement for those with complex needs, secure additional resources to support the first few support years of implementation, and prepare to provide support for Medi-Cal plans developing Medicare products for the first time.
To support Medi-Cal plans that are developing 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 to improve 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, and focusing on reaching providers through use data on current Medicare providers for a fee.
CHCF says MMPs in the state should focus on developing strategies to attract members to actively select their MMP to remain financially viable, including developing targeted outreach and marketing strategies to help people realize the benefits of integrated care to understand.
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 involvement with the Health Insurance Counseling and Advocacy Program, health insurers and Medicare brokers.
The report says the state should also focus on better engaging historically marginalized groups and Californians facing language barriers by developing resources that can support enrollment processes and equality downtown, and by actively monitoring inequalities in the use and results of services.
In January 2023, Medi-Cal managed care plans in the 7 Coordinated Care Initiative (CCI) provinces will create MMPs and transfer 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 highlighted the potential benefits of the MMP model.
“As the state rolls out this new model, stakeholders should prioritize clearly communicating the benefits of a realigned approach for dual-eligible Californians and their providers, monitor how these new plans work, and evaluate the impact on enrollee experiences and whether aligned MMPs improve outcomes and address differences,” the report states.