March 27, 2013

California Dual Eligibles Agreement with CMS: More Work Needed

More Work Is Needed to Protect Older Adults and People with Disabilities 

OAKLAND, CA – Today, California’s Department of Health Care Services (DHCS) and the federal Centers for Medicare and Medicaid Services (CMS) announced an agreement to redesign the way Medi-Cal and Medicare services are delivered to low-income older adults and people with disabilities in California.

Under the agreement, dual eligibles will be automatically enrolled into capitated managed care plans responsible for delivering all Medicare and Medi-Cal services in exchange for a single payment. The payment will be less than the two programs spend on the population today. Enrollment will begin this October. As many as 456,000 people will be impacted.

“The agreement between DHCS and CMS reveals that significant work remains to be done to ensure that low-income older adults and persons with disabilities will be protected. The combination of complexity, size, speed and cost savings raises serious concerns about how beneficiaries will fare in this new system,” said Kevin Prindiville, Deputy Director of the National Senior Citizens Law Center.

California is the fifth state to enter into such an agreement and the fourth state to rely on capitated managed care plans. California’s demonstration will be nearly four times larger than any other state. The agreement caps enrollment in Los Angeles County at 200,000, a welcome recognition of concerns raised by NSCLC and other advocates about the demonstration’s size, but enrollment in that county alone will be significantly larger than the total in any other state.

California will also move forward more quickly than most other states, opting to begin the demonstration (in all counties except for Los Angeles) with passive enrollment (meaning dual eligibles will be automatically placed into plans). This is instead of starting with an initial period of voluntary enrollment as other states have done. For example, Illinois, which reached an agreement with CMS earlier this month, will begin a voluntary enrollment period this October, but will not start passive enrollment until January.

The agreement does include consumer protections to address the challenges of redesigning the delivery system. “We are pleased to see a commitment from CMS and DHCS to develop an ombuds program to ensure that beneficiaries have the help they will need to access services and providers under this new model,” Prindiville explained. “We look forward to working with them to make this operational and on other consumer protections.”

Other consumer protections include the right to disenroll or change plans at any time for Medicare benefits, significant care continuity provisions and the use of an independent enrollment broker. The agreement also adds some new benefits for dual eligibles such as vision and dental services.

Next week, NSCLC will announce a comprehensive training and technical assistance project designed to help California advocates understand these changes and assist older adults and persons with disabilities through this transition.


The National Senior Citizens Law Center is a non-profit organization whose principal mission is to protect the rights of low-income older adults. Through advocacy, litigation, and the education and counseling of local advocates, we seek to ensure the health and economic security of those with limited income and resources, and access to the courts for all. For more information, visit our Web site at

# # #
Contact: Scott L. Parkin
202.683-1996 direct
703.975.1769 cell