The obstacle-plagued California demonstration program for Medicare-Medicaid dual eligibles hit another hurdle last month as state officials dropped Alameda County and its 26,000 eligible duals from the initiative. The state also is delaying the start of passive enrollment for the demo in Orange County by another month because a needed audit report from CMS regarding the CalOptima duals plan there may not be completed in time for beneficiary notices to go out for the earlier date.

Neither development is likely to have a huge impact on California’s CMS-backed duals demo, which remains the nation’s largest with now 430,000 eligible beneficiaries in seven counties. But it does mean that enrollment in the demo is likely to continue trailing earlier expectations well into next year.

The factor causing the change in Alameda County is continuing financial difficulties of the Alameda Alliance for Health, a publicly operated plan that had been slated to be the sole insurer participating in Alameda County. The plan this year was put under state conservatorship as a result of its financial woes, and those same issues led to what Mari Cantwell, chief deputy director of health care programs for California’s Department of Health Care Services (DHCS), told California Healthline was a “joint decision” also involving the state Department of Managed Health Care and providers to remove Alameda from the duals initiative.

The significant amount of work needed to prepare for the duals project “is not the best thing to be focusing on now for Alameda Alliance,” according to Cantwell. The Alameda Alliance conservatorship is scheduled to end July 23, 2015.

California’s most recent data for enrollment in the duals demo show figures substantially trailing earlier expectations even before the new delay and withdrawal. Total active enrollment as of Nov. 1 was 51,527, DHCS reported, with almost half of those coming from Los Angeles County (see table, below). The November figure was up only from 48,976 on Oct. 1, and the pending December enrollments are just 11,967, DHCS data showed, although 106,211 more enrollees now are slated to join the demo in January.

There was some good news in the same report, though. The opt-out rate in Los Angeles County stood at 39.70% of passive enrollment as of Nov. 1, down from 49.77% on Oct. 1, DHCS said. That still means 107,685 duals have asked to be excluded from the program, California Healthline noted, but it added that the figure could be misleading since beneficiaries can opt out any time in the enrollment process, while enrollments aren't counted until automatic passive enrollments actually take effect.

Excerpted from the 12/4/14 issue of AIS’s Medicare Advantage News