In order to develop a more integrated system of care and to save the state money, the state has in recent years taken steps to reform the way that Medi-Cal and Medicare funded services are provided. Until recently, individuals who received either Medi-Cal or Medicare were able to receive services through multiple service providers, including doctors, therapists, adult day health care centers, and homecare workers (including IHSS). Legislation passed in 2010 required individuals who receive Medi-Cal only to be enrolled in managed care plans, which are responsible for coordinating most of their medical and social care needs, but not IHSS. The Department of Health Care Services (DHCS) began enrolling individuals in managed care plans early last summer. In addition, the State of California was recently awarded a federal grant to implement pilot programs in four counties that will enroll individuals who receive both Medi-Cal and Medicare (commonly known as "dual eligibles") in managed care plans.
As part of his 2012-2013 budget, Governor Brown has proposed to expand the four-county pilot to include up to 10 counties beginning January 1, 2013. Dual eligibles in all other counties would be enrolled in managed care plans starting in 2014. By 2016, over 1.2 million dual eligible individuals would be enrolled in managed care plans throughout the state. Enrollment in the plans would be a phased-in process. Dual eligibles would be sent a notice with the option to select a managed care plan (in most counties), or to opt out of enrollment for the Medicare portion only. Individuals who do not make a selection would be automatically enrolled in a plan. Once enrolled, they would have to remain in the managed care plan for six months, but would be able to continue receiving services from an out-of-network provider if certain criteria are met.
Under the governor's proposal, managed care plans would be responsible for identifying and coordinating all medical, social, and long-term care service needs through care coordination teams that include the individual, health plan representatives, doctors, county social service staff, and others. Long-term care services that would be impacted include several waiver programs, Multipurpose Senior Services Programs (MSSPs), skilled nursing facilities, In-Home Supportive Services (IHSS), and Community-Based Adult Services (CBAS - this program will begin being offered through managed care plans in April 2012).
Through 2013, the IHSS Program would operate the same as it does today. County social workers would continue to determine program eligibility, conduct assessments, and process IHSS timesheets. IHSS public authorities, such as PASC, would continue to act as the employer of record for collective bargaining, operate registries to assist consumers with locating providers, and provide trainings and other support services. Managed care plans would be able to authorize additional IHSS hours for consumers, or provide other services to improve their overall care. Managed care plans would not be able to decrease hours for consumers during the first year.
Beginning in 2014, IHSS hours would be determined through a joint assessment process with county social workers and health plans. Health plans would be able to authorize other services to better meet the consumer's needs. At this time, it is not known if services provided by public authorities would be impacted by this change. It is also not known if additional changes to IHSS would be made beyond 2014.
For the last several months, DHCS has worked with Harborage Consulting to gather stakeholder input on the plan to implement the four-county pilot, and the governor's proposed expanded pilot. Many in-person and phone-based hearings have been held throughout the state, and will continue to be held through 2012. In addition, several state senate and assembly hearings will be held over the next several months to discuss the governor's proposals for managed care. At a Senate Budget Sub-Committee hearing held on February 23rd, three expert panels discussed the proposals, and public comment was heard. Many individuals who testified believe the governor's proposals to expand the four-county pilot and shift long-term care services into managed care are premature.
For additional information on the pilot programs and opportunities to provide input, please visit DHCS' website at www.calduals.org.
Many recent proposals, such as the ones mentioned above, could have significant impacts on the IHSS Program and the way you receive your care. Whether you are an IHSS consumer, a homecare worker, a family member or friend of a consumer, it is important that you stay informed about all the discussions that are taking place throughout the state. Below are several ways you can stay informed.
If you are an IHSS provider and have had no payroll activity on the state's Case Management Information and Payroll System (CMIPS) for one year, the state will automatically terminate your eligibility to provide IHSS services, and you will be required to complete all provider enrollment requirements AGAIN.