As previously reported, Governor Brown has proposed to reform the way that Medi-Cal and Medicare funded services are provided, and to develop a more integrated system of care while saving the state money. 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 and the award of a federal grant from the Centers for Medicare & Medicaid Services (CMS) authorized the state 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. On April 4th, the state announced that the four counties selected for the pilot are San Diego, Orange, San Mateo and Los Angeles Counties. In L.A. County, the two health plans selected to participate in the pilot are L.A. Care and Health Net. Governor Brown has also proposed to expand the four-county pilot to include up to 10 counties beginning January 1, 2013. The program would expand to 20 additional counties in 2014, and throughout California in 2015. These expansions would, however, require additional state legislation. 

Under the pilots, managed care plans will be responsible for identifying and coordinating all medical, social, and long-term care services. IHSS will become a Medi-Cal benefit that is only available through managed care plans. It is anticipated that health plans will contract with several agencies to administer IHSS including the counties (to determine program eligibility, conduct assessments, and process IHSS timesheets), and IHSS public authorities (to serve as the employer of record for collective bargaining, operate registries to assist consumers in locating providers, and provide trainings and other support services). IHSS consumers will maintain the right to hire and fire their own providers. Managed care plans will work with each consumer's care coordination team to determine if additional IHSS hours, or other services, are needed to improve the consumer's overall care.

Although L.A. County has been selected for the pilot program, and L.A. Care and Health Net have been identified as the participating health plans, there are still many unanswered questions related to enrollment in the health plans, and how IHSS and other services will be administered in the pilot counties. Before implementation, the state must get approval for the pilots from CMS, and issue a draft of the proposal they will submit after a mandatory 30-day public comment period. To view the state's draft proposal and submit comments, please visit the Department of Health Care Service's website at www.calduals.org.

Additional information on the managed care pilot in L.A. County will be published in future editions of the PASC E-News as it becomes available. 

Access Services is in the process of establishing a new program for clients who sometimes need to travel with their children on paratransit vans. The new program is a premium service designed to assist parents who need to get their children to school, recreational activities, and healthcare appointments.

To help gather community input on this new program, Access is coordinating two community meetings on April 24th (see below). In addition, input can be given via telephone or e-mail by contacting Madge Gaynor at 909-627-2974 ext. 259, or at mgaynor@arellanoassociates.com.

Tuesday, April 24th

11 AM - 12:30 PM

Chatsworth Train Station - Chatsworth Porter Ranch Chamber of Commerce

10038 Old Depot Plaza Road

Chatsworth, CA 91311

Cross St.: Lassen St.

Tuesday, April 24th

6 PM - 7:30 PM

Ability First

6530 Winnetka Ave.

Woodland Hills, CA 91367

Cross St.: Gilmore St.

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Forum on the Future of Long-Term Care