Congressional delegates worried about managed care move for seniors

Several members of the Los Angeles congressional delegation asked the federal government Tuesday to postpone moving hundreds of thousands of chronically ill seniors and disabled patients into managed care.

In a letter, signed by 14 U.S. representatives, the officials raised concerns about whether the health plans would be ready for the transition and whether patients would have access to the care they need.

The state and the federal government signed an agreement in March establishing the program for the “dual eligible” patients, who receive both Medicare and Medi-Cal. About 450,000 patients, including 200,000 in Los Angeles County, are expected to be enrolled in the program.

California health officials have said the program will lead to savings and better care because the patients will be receiving more coordinated medical, social and mental health services. But advocates worry beneficiaries will lose access to their current doctors and medications.

Rep. Linda Sanchez (D-Lakewood), who led the call for a delay, said in an interview that the dual-eligible patients are vulnerable and deserve to have a smooth transition without any interruptions in care. Slowing down the process could help ensure that the state and federal government get it right, she said.

In the letter to the head of the Centers for Medicare & Medicaid Services, the representatives said they had heard concerns from providers and patient advocacy groups that the savings targets were overly ambitious and arbitrary and could result in pared down services.

“We are very concerned that, in the effort to create savings, patients could be denied access to quality care,” they wrote.

The California Department of Health Care Services said in a statement Tuesday that it recently moved the start date from fall to January 2014 at the earliest, and that health officials were working to do what’s right for Medi-Cal members while implementing a “historic effort” to provide more coordinated care. The department will do a review to ensure that the plans are ready and that the networks of providers are adequate, according to the statement.

“This kind of complex systematic change takes time,” the statement read. 

Disability Rights California legislative advocate Deborah Doctor said she was grateful for the letter from the U.S. representatives and hoped that the project would be postponed. Doctor said she and other advocates want to see concrete details on how the plans will care for the patients and how the state will oversee the process.

Under managed care, health plans will be paid to coordinate all of a patient's care rather than doctors being paid based on the number of services provided. Experts say this could reduce costs by helping more patients stay in their homes and reducing unnecessary trips to nursing homes and hospitals.

The project will take place in eight counties: Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, Alameda and Santa Clara.


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