Aged, Blind, Disabled Moving Into Managed Medi-Cal in California Health Insurance

Last month, state officials began informing more than 380,000 aged, blind and disabled Californians receiving subsidized health coverage that they need to choose a managed Medi-Cal plan in the coming months.

Mandatory managed care for this “high-touch” population of seniors and persons with disabilities (known as SPDs in the acronym-prone world of health care) is part of a sweeping Medicaid waiver negotiated last year between California and CMS. Called California’s “Bridge to Reform,” the waiver will bring about $10 billion in federal funds over the next five years to invest in the state’s health delivery system and to help pay for changes required by federal health care reform.

Some of the money is aimed at changes designed to help slow the rate of growth in health care costs within the Medi-Cal program. State officials think shifting SPDs into managed care will save money and improve care simultaneously. They predict blind, disabled and frail elderly beneficiaries — a needy population that accounts for a large portion of Medi-Cal’s annual budget — will receive improved care coordination, improved management of chronic conditions and overall better health outcomes through managed care. Ultimately, they hope those improvements will bring Medi-Cal’s costs down.

When it was approved in November last year, California Department of Health Care Services spokesman Norman Williams said the waiver “allows us to completely restructure California’s health care system, and to rein in costs in Medi-Cal.”

Moving SPDs into managed care is California tugging at those reins.

The state estimates managed Medi-Cal will cost about 10% less than fee-for-service for this population.

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