In this webinar, Amber Cutler is a staff attorney with National Senior Citizens Law Center, talks about: > What is the CCI? > Who is affected by the CCI? > How are beneficiaries with developmental disabilities affected by the CCI? > How does enrollment work in Los Angeles County and beyond? > What can advocates do to help themselves, their loved ones and their clients?

1. California Coordinated Care Initiative: What
Self-Advocates and Families Need to Know
By Amber Cutler & Michelle Rojas Soto
February 12, 2015

2. Structure and Logistics
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4. About Michelle Rojas Soto
Moderator
USC UCEDD Director of Community Education,
Information Dissemination and Technical
Assistance
mrojassoto@chla.usc.edu
www.uscucedd.org
The USC University Center of Excellence in Developmental Disabilities at
Children’s Hospital Los Angeles (USC UCEDD) is one of 67 centers around the
country. Our mission is to provide leadership in strengthening family-centered,
culturally-competent services and systems for the benefit of individuals with, or
at risk for, developmental, behavioral and/or special health care needs and their
families in partnership with those who utilize the services.

5. About Amber Cutler
Presenter
Staff Attorney
National Senior Citizens Law Center
acutler@nsclc.org
http://www.nsclc.org
The National Senior Citizens Law Center is a non-profit organization whose
principal mission is to protect the rights of low-income older adults. Through
advocacy, litigation and the education and counseling of local advocates, we seek
to ensure the health and economic security of those with limited income and
resources, and access to the courts for all.

6. Glossary
• Coordinated Care Initiative (CCI)
– Cal MediConnect
• Dual Eligible (Dual)
• Duals-Special Needs Plan (D-SNP)
• Fee-for-Service (FFS)
• Long Term Services and Supports (LTSS)
– In-Home Supportive Services (IHSS), Community Based Adult
Services (CBAS), Multipurpose Senior Services Program (MSSP),
Nursing Facility
• Medi-Cal Managed Care
• Program of All-Inclusive Care for the Elderly (PACE)
• Seniors and Persons with Disabilities (SPDs)
6

7. CCI = three big changes
7
CCI Change Description
Mandatory Medi-Cal
Managed Care
Duals and previously excluded SPDs must
enroll in Medi-Cal Managed Care
LTSS Integration LTSS added to Medi-Cal Managed Care
plan benefit package
Medicare Integration
(Cal MediConnect)
For duals, integration of Medicare and
Medi-Cal benefits into one managed care
plan.

8. The current Medi-Cal, LTSS, and
Medicare delivery systems are different
Medi-Cal
(medical services)
Medi-Cal
(LTSS services)
Medicare
Managed
care
Managed
care
FFS FFS
FFS
(default)
OR OR
*Behavioral Health
Current System
8

9. CCI moves services into
managed care
Medi-Cal
(medical services)
Medi-Cal
(LTSS services)
Medicare
Managed Care
New System
*Behavioral Health
9

10. Managed Care: Plans paid to provide
covered services via network providers
10
Senior/Person
with Disability
Provider
DHCS &
Medicare
Provider Provider
$$
Health Plan
DHCS &
Medicare
$$

11. Medi-Cal and
Medicare
(Dual Eligibles)
Medi-Cal only
(SPDs)
Medicare Only
Impacted
Not
Impacted
CCI impacts duals & seniors and persons
with disabilities with Medi-Cal
11

12. Different groups of DUALS and
SPDs are affected differently
12
Medi-Cal Only
(SPDs)
• Nursing Facility
Residents
• Share of Cost
Medical Exemption
Request (MER)
Available
Duals
Not CMC Eligible
• Regional Center
Clients
• ESRD Diagnosis
• In Waivers
STILL HAVE TO CHOOSE
A MEDI-CAL plan
Duals
Who Won’t Get
CMC Notices
•In certain Medicare
plans
•In Kaiser
STILL HAVE TO CHOOSE
A MEDI-CAL plan
Exceptions: Duals and SPDs who reside in an ICF/DD, Veteran’s Home, or
who have Other Health Coverage do not have to join a plan.

13. Total Impact: 1,125,000
13
County Duals Subject to Passive Enrollment
in Cal MediConnect
Medi-Cal MC Only
Alameda 32,533 48,000
Los Angeles 288,399 (200,000 cap) 317,000
Orange* 65,537 51,000
Riverside 40,040 46,000
San Bernardino 41, 930 54,000
San Diego 55,798 64,000
San Mateo 12 371 14,000
Santa Clara 37, 739 38,000
Totals 574, 347 ( 485,948 with cap) 632,000

14. Regional Center Clients Still Have
to Choose a Medi-Cal Plan
14
Regional
Center
Client
Medi-Cal
Passive
Enrollment

15. www.NSCLC.org 15
Enroll
Dual
Choose a Medi-Cal Plan
Do Nothing
Enrolled into
Medi-Cal Plan

16. What is the Medi-Cal Plan
Responsible For if You’re a Dual
16
• The Medi-Cal plan is responsible for benefits Medicare does not pay
for:
• Long-Term Services and Supports – In-Home Supportive Services ,
MSSP, CBAS, and Nursing Facility Care
• Medi-Cal transportation services
• Durable Medical Equipment
• Certain Prescription Drugs
• Medi-Cal Supplies
• The Medi-Cal Plan Pays the Medicare Provider the 20% Co-Insurance
• The Medicare provider DOES NOT have to be contracted with the Medi-
Cal plan to bill the plan for the 20% co-insurance

17. Los Angeles Medi-Cal Plans
17
• LA Care
– Plan Partners
• Anthem Blue Cross
• Care 1st
• Kaiser
• Health Net
– Plan Partner
• Molina

18. CCI will be implemented in 7
counties
Alameda
Los Angeles
Orange
Riverside
San Bernardino
San Diego
San Mateo
Santa Clara
18

19. Timeline – Los Angeles County
19
• Most Duals who only have to choose a Medi-Cal plan
do so by birth month (August 2014 Start Date)
• Duals in Medicare Advantage Plans have to choose a
Medi-Cal plan (January 2015 start date)*
• SPDs not already in a Medi-Cal plan choose one by
birth month (August 2014 start date)
*July – January in January, then by birth month

20. Most beneficiaries will receive
three notices
90 Day 60 Day 30 Day ENROLLMENT
6/1/14
10/1/14
7/1/14
11/1/14
8/1/14
12/1/14
ENROLLMENT
9/1/14
ENROLLMENT
1/1/15
September
DOB
January
20

21. www.NSCLC.org 21
90 Day
60 Day
30 Day
• Informational Notice
• Notice with Default Plan
• Guidebook
• Choice Booklet and Choice Form
• Final Reminder Notice
When

22. 22
90-Day Medi-Cal Managed Care Notice

23. 23
60-Day Medi-Cal Managed Care Notice

24. 24
90-Day Cal MediConnect Notice

25. 25
60-Day Cal MediConnect Notice

26. What can you do?
• Influence program development
– Stakeholder meetings
– Talk to plan
– Legislative advocacy
• Prepare to provide counsel
• Report problems
26

27. Local advocates can help
individuals
• HICAP
1-800-434-0222
• CCI Ombudsman
1-855-501-3077
27

28. Want to know more?
• NSCLC Duals Website
– Advocate’s Guide
– News
– Sign up for alerts
http://dualsdemoadvocacy.org
• Contact us:
– Amber Cutler – acutler@nsclc.org
– Denny Chan – dchan@nsclc.org
Wrap Up
28
• Disability Rights Education &
Defense Fund (DREDF)
- www.dredf.org
• Department of Healthcare
Services
- www.calduals.org

29. Poll: Do you have a better understanding of
CCI and how it affects you now?

30. Ask Me a Question
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