As part of the statewide CalAIM initiative, Medicare and Medi-Cal dual enrollments will soon be able to enroll in Medicare Medi-Cal Plans (MMPs) to improve the coordination of all Medicare and Medi-Cal benefits and empower these dual-eligible Californians to facilitate navigating 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 intention of the MMPs is “…to provide comprehensive care management, streamlined member notification materials, a single insurance card for both plans, single provider directories and prescription forms, and a unified complaints and appeals process.”
According to CHCF, coordinated MMPs can reduce duplication and confusion in care coordination, prevent delays in obtaining durable medical devices, challenge participants for specific non-medical support to meet social needs, and improve care outcomes and satisfaction.
“A study comparing outcomes for dual-eligible individuals in integrated models versus those in regular, unaligned MA plans found that many of the more integrated models were associated with increases in HCBS and less institutionalization,” the statement said 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 participants to ensure appropriate reimbursement for those with complex needs, additional funding to support first-timers Securing and preparing for years of implementation provides support for Medi-Cal plans developing Medicare products for the first time.
To support Medi-Cal plans to 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 helps them choose MMPs and the Medicare expertise at Medi-Cal organizations would improve.
To support provider network development and robust enrollment, the report recommends encouraging providers to join the network by increasing payments to providers and better targeting provider outreach by using data on current Medicare fee-paying providers will.
According to the CHCF, MMPs in the state should focus on developing strategies to encourage members to actively choose their MMPs to remain financially viable, including developing targeted outreach and marketing strategies to help people realize the benefits of the integrated to understand supply.
According to the 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 collaboration with the Health Insurance Counseling and Advocacy Program, health insurance agents and Medicare brokers.
The report says the state should also focus on better including historically marginalized groups and Californians who face language barriers by developing resources that can support the enrollment process and focus on equity and inequalities in use and actively monitors the results of the services.
In January 2023, Medi-Cal Managed Care plans will establish MMPs in the 7 Districts of the Coordinated Care Initiative (CCI) and transition members from Cal MediConnect plans to 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 clearly communicate the benefits of a coordinated approach to dual eligible Californians and their providers, monitor how these new plans are performing, and assess the impact on enrollment experiences and whether coordinated MMPs are the outcomes improve and address inequalities,” says the report.