Federal-state MOU to integrate care for Medicare-Medi Cal beneficiaries

CMS and the California Department of Health Care Services announced on March 27 that they have entered into a Duals Demonstration Memorandum of Understanding (MOU) to integrate care for dual eligible Medicare and Medi-Cal beneficiaries as part of California’s Coordinate Care Initiative. Under the agreement, contractor plans are required to provide for Medicare and Medicaid-covered services under a capitated model of financing.

The new payment and service delivery demonstration, which will be called the Cal MediConnect program, allows up to 456,000 total Medicaid-Medicaid beneficiaries to participate from eight counties: Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo and Santa Clara. Eligible beneficiaries are able to enroll no sooner than Oct. 1, 2013.

The partnership includes a three-way contract with demonstration plans, jointly selected by CMS and Calif., to provide integrated benefits to Medicare-Medicaid beneficiaries. The initiative seeks “to alleviate the fragmentation and improve coordination of services for Medicare-Medicaid enrollees, enhance quality of care and reduce costs for both the state and the federal government,” according to language in the MOU.

“CMS and California expect this model of integrated care and financing to, among other things, improve quality of care and reduce health disparities, meet both health and functional needs, and improve transitions among care settings,” according to the MOU, adding that the ability to self-direct care and live independently in the community “are central goals of this initiative.”

A copy of the MOU can be found here.