BILL ANALYSIS Ó
AB 461
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB
461 (Mullin)
As Amended June 1, 2015
Majority vote
--------------------------------------------------------------------
|ASSEMBLY: |79-0 | (May 14, |SENATE: |39-0 |(July 9, 2015) |
| | |2015) | | | |
| | | | | | |
| | | | | | |
--------------------------------------------------------------------
Original Committee Reference: HEALTH
SUMMARY: Authorizes a beneficiary receiving services through a
regional center who resides in the County of San Mateo to
voluntarily enroll in the Cal MediConnect demonstration project
under the Coordinated Care Initiative (CCI), as specified.
The Senate amendments clarify that a dual eligible beneficiary,
or an individual who is eligible for both Medicare and Medi-Cal,
who is receiving services through a regional center located in
San Mateo County, is eligible to enroll in the Cal MediConnect
demonstration project, even if he or she is already enrolled in
a federal home- and community-based waiver.
FISCAL EFFECT: According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
AB 461
Page 2
COMMENTS: According to the author, in San Mateo County, Health
Plan of San Mateo (HPSM) serves about 12,000 dual eligible
beneficiaries (beneficiaries eligible for both Medicare and
Medi-Cal) through its dual-eligible special needs plan (D-SNP),
the vast majority of whom transitioned into the CCI this year.
The author states that approximately 600 dually eligible
developmentally disabled individuals remain in the D-SNP;
however, HPSM may close its D-SNP due to the costly nature of
running a program for such a small population, leaving this
population without a health plan that would integrate and
maximize Medi-Cal and Medicare benefits. The author concludes
that by allowing this population to voluntarily enroll in the
CCI, HPSM will be able to continue to provide them with the
option of managed care.
1)CCI. The 2012 state budget authorized the CCI, a program
intended to integrate and coordinate the delivery of health
benefits, including behavioral health benefits and long-term
services and supports to dual eligibles and seniors and
persons with disabilities living in specified counties,
including San Mateo County. The CCI includes the Cal
MediConnect Program, a three-year demonstration project
designed to coordinate medical, behavioral health, long-term
institutional, and home- and community-based services by
combining Medicare and Medi-Cal benefits into one integrated
health plan. Certain dual eligible beneficiaries are not
permitted to participate in Cal MediConnect, including
individuals with developmental disabilities receiving services
through a regional center.
2)HPSM. In certain counties, Medi-Cal managed care is operated
by a single County Organized Health System (COHS). San Mateo
County is a COHS county, and HPSM is the single plan to serve
all Medi-Cal beneficiaries enrolled in managed care. As such,
HPSM operates the only Cal MediConnect plan called
CareAdvantage. Passive enrollment into CareAdvantage
commenced in April 2014, and as of March 2015, 10,100 dual
eligibles were actively enrolled in Cal MediConnect. San
Mateo County has an enrollment rate of 84%, with 13% of dual
eligibles opting out of Cal MediConnect, and 4% disenrolling
from Cal MediConnect. The enrollment rate is significantly
higher than any other CCI county.
AB 461
Page 3
HPSM also operates a D-SNP in which developmentally disabled
individuals receiving care from a regional center are
enrolled. A D-SNP is a type of Medicare Advantage plan that
limits membership to people with specific diseases or
characteristics, and tailors their benefits, provider choices,
and drug formularies to best meet the specific needs of the
groups they serve. D-SNPs serve dual eligibles, and similar
to Cal MediConnect plans, D-SNPs combine Medicare and Medicaid
benefits into one plan.
Under the CCI, D-SNPs operated by plans that also operate a
Cal MediConnect plan will be phased out. In January 2015,
beneficiaries enrolled in a D-SNP operated by a Cal
MediConnect plan were transitioned into Cal MediConnect.
Additionally, beneficiaries who are eligible for Cal
MediConnect will not be able to enroll in a D-SNP after
January 2015.
Support. HPSM supports this bill stating that it serves dual
eligibles, 600 of which are developmentally disabled and receive
care through its SNP. HPSM states that the SNP is costly and
inefficient to operate for only 600 members, and it intends to
close the SNP in the next year or two, potentially leaving the
600 developmentally disabled members without a consolidated
health plan to maximize Medi-Cal and Medicare benefits. HPSM
states that this bill will correct this problem by allowing this
special needs population to voluntarily enroll in Cal
MediConnect. According to HPSM, this bill also enjoys the
support of the local San Mateo County disability rights
community.
Golden Gate Regional Center (GGRC), the regional center serving
San Mateo County, and other supporters state that persons with
developmental disabilities who are enrolled in HPSM's D-SNP
should have the option to continue with HPSM through the CCI.
GGRC states that the inability of these individuals to continue
with HPSM through the CCI would be extremely disruptive to their
AB 461
Page 4
care, and without the option for voluntary CCI enrollment
created under this bill, the alternative for these beneficiaries
will be a fragmented system between Medicare fee-for-service and
Medi-Cal through HPSM.
Opposition. There is no opposition on file.
Analysis Prepared by:
Kelly Green / HEALTH / (916) 319-2097 FN:
0001070