Duals Integration Demonstration

Dual Eligibles Coordinated Care Demonstration

California is one of 15 states awarded a federal contract to develop new models of coordinated care for people eligible for both Medicare and Mediciad (Medi-Cal), also known as dual eligibles. California has about 1.15 million dual eligibles. Dual eligibles tend to have many chronic health conditions and rely on services from numerous providers. Currently, only a small portion of California's dual eligibles are enrolled in organized care systems.

The Dual Eligibles Coordinatd Care Demonstration will involve models through which one entity is coordinating care for the total needs of a person – medical and social. That includes behavioral health, social supports, medical care, and long-term care. This design could take a number of different forms. It does not necessarily imply that demonstration sites control home- and community-based services; however there is an expectation that all services are coordinated and the care experience is seamless for the beneficiary. Significant collaboration between the State, counties, beneficiaries, providers, health plans and advocates will be needed to develop successful models.

DHCS is working closely with the Federal Medicare-Medicaid Coordination Office within the Centers for Medicare and Medicaid Services (CMS) to prepare for a Demonstraton launch in January 2013. For more background, read this Demonstration Overview.

For information or questions email duals@dhcs.ca.gov. Also, stay updated by following @CalDuals on Twitter.

February Updates:

New! Legislative Language on the Brown Administration's Coordinated Care Initiative (PDF)

New! Fact Sheet on the Coordinated Care Initiative Legislation (PDF)

New! Timeline for the Coordinated Care Initiative (PDF)

New! Savings Estimates and Methodology for the Coordinated Care Initiative (PDF)

DATA: Click here to see latest Medi-Cal dual eligible enrollment by county.

January Updates:

New! The Medi-Cal Procurement Office has posted the Final Request for Solutions and supporting documents. Download them here.

See the changes made to the Final Request for Solutions. Download the Final RFS with Edits revealed in track changes (PDF 1 mb)

New! CMS guidance to health plans interested in offering capitated financial models for the duals demonstration (PDF).

New! CMS Health Plan Guidance PowerPoint Slides (PDF)

Draft Request for Solutions (RFS) Comments: Fifty-four organizations and individuals submitted comments to the draft RFS releasd Dec. 22, 2011. Download the full list of commenter names (PDF). The comments are available in the following three documents listed alphabetically by organization (A-C), (D-M) and (N-Z).

A-C Comments (PDF 2 mb)

D-M Comments (PDF 3.3 mb)

N-Z Comments (PDF 6 mb)

IHSS Consumers Union's List of Demands (PDF)

The Medi-Cal Procurement Office organized all the comments by issue area. Download the 194-page comment worksheet: Dual Eligible Final Comment Sheet (PDF 2 mb)

Stakeholder meeting summaries posted below in the meeting section. Comment period is closed for draft Request for Solutions. Watch for the final document release.

December Updates

Draft Request for Solutions released. Download it here.

Comment Submission: Comments on the document should be sent to the DHCS Procurement Office by 5 pm Jan. 9, 2012 through the email address OMCPRFP9@dhcs.ca.gov. Please note that the Draft RFS incorrectly stated on page 13 that "comments should be submitted using the Procurement Office's template." This was a mistake, as there is no formal template. All comments should reference the page and section number of the document.

Download the updated process timeline.

A recent report by the California State Auditor found that oversight of Medi-Cal managed care plans needed to improve. DHCS agrees with the recommendations and is in the process of establishing policies and procedures that will ensure consistency and timeliness of reviews. Read the California State Auditor report here: (http://www.bsa.ca.gov/pdfs/reports/2011-104.pdf)

Click here for a report on focus groups with California Beneficairies sponsored by the Medicare-Medicaid Coordination Office.