BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
AB 2206 (Atkins) - Medi-Cal: dual eligibles: pilot projects.
Amended: August 6, 2012 Policy Vote: Health 7-0
Urgency: No Mandate: No
Hearing Date: August 6, 2012
Consultant: Brendan McCarthy
This bill does not meet the criteria for referral to the
Suspense File.
Bill Summary: AB 2206 would expand the ability of people who are
dually eligible for Medi-Cal and Medicare to enroll or remain
enrolled in Programs for the All-Inclusive Care for the Elderly
(PACE).
Fiscal Impact: According to the Department of Health Care
Services, as part of its implementation of the Coordinated Care
Initiative, it will be setting capitation rates for PACE that
are similar to those paid to managed care plans for the
provision of similar services to a similar population. Therefore
the Department indicates that additional use of PACE by
dual-eligibles should not increase overall Medi-Cal costs.
Background: PACE is a capitated benefit provided to Medi-Cal and
Medicare beneficiaries who are over 55 years of age and eligible
for nursing home care. PACE provides comprehensive services to
enrollees, based on the participant's specific needs. Through
PACE, these services can often be provided outside of a nursing
home, keeping individuals in the community and reducing costs.
The PACE organization is paid a capitated rate and is liable for
all health care costs of participants, including nursing home
care. Enrollment in PACE is voluntary by the participant.
The enacted 2012-13 budget includes the Coordinated Care
Initiative, which expands an existing four county pilot project
for the integration of Medi-Cal and Medicare services, so that
the program will be operational statewide by 2015. Under the
Coordinated Care Initiative, dually-eligible individuals will be
required to enroll in Medi-Cal managed care plans and will be
passively enrolled in managed care for Medicare services.
Long-term support services, such as In Home Supportive Services,
AB 2206 (Atkins)
Page 1
will be provided through managed care. In areas where PACE is
available, individuals will be allowed to enroll in PACE. The
Coordinated Care Initiative includes a six month "lock-in"
period in the managed care plan. After six months, an individual
can opt to change managed care plans, enroll in a Medicare
Advantage plan, fee-for-service Medicare, PACE, or certain other
programs.
Proposed Law: AB 2206 would provide more flexibility to
dually-eligible individuals who are currently enrolled in PACE
or who may become eligible for PACE.
Specifically, the bill would provide that:
Individuals who are already enrolled in PACE at the time of
mandatory enrollment in managed care shall remain in PACE
and not be sent alternative enrollment information.
Individuals who become eligible for PACE and are enrolled
in a managed care plan are exempted from the lock-in period
and may disenroll from their manage care plan and enroll in
PACE.
Managed care plans are required to periodically assess
beneficiaries over 55 years of age who are at risk for
placement in a nursing home and notify them of their
potential eligibility for PACE.
Related Legislation:
SB 208 (Steinberg, Chapter 714, Statutes of 2010)
established the four county demonstration project for the
integration of Medi-Cal and Medicare benefits for
dually-eligible individuals.
SB 574 (Lowenthal, Chapter 367, Statutes of 2011) increased
the number of PACE organizations that can enter contracts
with the Department of Health Care Services from 10 to 15.
SB 1008 (Committee on Budget, Chapter 33, Statutes of 2012)
a budget trailer bill, implements the Coordinated Care
Initiative, expanding the demonstration project for
dual-eligible individuals statewide.
Staff Comments: The recently adopted author's amendments avoid
chaptering issues with the SB 1008.
AB 2206 (Atkins)
Page 2