The 2012-2013 state budget provides legislative approval for the governor’s Coordinated Care Initiative, which will enroll individuals eligible for Medicare and Medi-Cal (known as “dual eligibles”) into managed care plans for the provision of all their medical and social service needs, including IHSS. The initiative will be rolled out through the state over a three-year period, beginning with implementation in eight pilot counties no sooner than January 2014. L.A. County has been selected as one of the eight pilot counties. By 2017 over 1.2 million dual eligible individuals will be enrolled in managed care plans throughout the state.
Affected individuals will receive several notices regarding plan selection beginning 90 days prior to the date they will be enrolled. Individuals will be able to select the plan of their choice (L.A. Care or Health Net in L.A. County), or may choose to opt out of receiving Medicare services through a health plan. However, if they opt out, they must still be enrolled in a health plan for the provision of Medi-Cal services, including IHSS. Individuals who do not make a selection will automatically be enrolled in a plan. Once enrolled, they will have to remain in the managed care plan for six months, but will be able to continue receiving services from an out-of-network provider if certain criteria are met. Certain groups of individuals will be exempt from the pilot, including those who are under 21 years of age, are enrolled in a Home and Community-Based Services waiver, have been diagnosed with HIV/Aids, or have been determined by the Department of Health Care Services to be ineligible for other medically necessary reasons.
The enacted legislation provides certain protections for consumers including, 1) the right to choose if they want services in a community-based setting, 2) the right to select their healthcare providers (within the plan network), 3) the right to decide if they want their IHSS homecare worker to be a part of their care coordination team, and 4) the right to hire, train and fire their own IHSS homecare worker. CDSS will also be required to develop a 24-hour ombudsman hotline to assist beneficiaries with navigating the system and timely resolution of complaints.
The state budget also establishes the California In-Home Supportive Services Authority (a.k.a. State Authority) to serve as the statewide employer of record for IHSS homecare workers. The state authority will be made up of five members including the directors of the Departments of Social Services, Health Care Services, and Finance. An advisory board made up of consumers, providers, and community advocates will also be appointed. The state authority will take over collective bargaining on a per-county basis as counties are rolled into the duals demonstration project. Currently, the employer of record functions are handled at a local level, usually by IHSS public authorities like PASC. Public authorities will continue providing other services to the IHSS community (i.e., registry services, trainings, back-up services). Counties will continue to be responsible for the assessment and authorization of IHSS hours, as well as processing IHSS payroll.
Although the Coordinated Care Initiative has been enacted and signed into law, there are still many policies that must be developed by the state before implementation begins. In addition, the initiative must still be approved by the Centers for Medicare & Medicaid Services. For additional information, visit the Department of Health Care Service’s stakeholder website at www.calduals.org.
Update: September 7, 2012
The Department of Health Care Services (DHCS) has prepared several fact sheets regarding the Coordinated Care Initiative and posted them on www.calduals.org. Included is a list of frequently asked question about the IHSS program and its integration into managed care. Click here to download the IHSS sheet.