Transitions Prove Tough for Managed Care in California

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The Sunshine State seeks to hold down costs with managed care for its Medicaid population and seniors, but it's meeting resistance.

Change is never easy, but that’s been especially true of late in California, where efforts to expand managed in Medicaid and healthcare for the elderly have hit roadblocks.

An effort to shift 500,000 low-income seniors and disabled persons into managed care has faltered miserably, according to published reports, as mailings sent to those affected caused many to simply shift to new insurance coverage, and nearly have simply exercised their right to opt out of the change.

Federal officials encouraged California to merge those eligible for both Medicare and Medicaid into a single program in a demonstration project, instead of having Medicare pay for doctors’ visits and hospitalizations and Medicaid covering nursing and long-term care. The program called for patients to get a case manager and be placed in a managed care plan with a fixed monthly rate to cover all a patient’s needs.

But according to Kaiser Health News, many patients who feared losing doctors they knew or being forced to travel long distances had other ideas, and opted to stick with dealing with 2 bureaucracies. “I’m scared this is just going to turn into a big mess,” said Michael Williams, a 59-year-old with cerebral palsy told the newspaper.


Widespread rejection of the demonstration project for dual eligible comes as the state seeks to move 24,000 medically fragile seniors and disabled in rural areas into Medi-cal managed care, which began Monday as advocates began their annual conference and braced themselves for the worst.

While state officials said the shift should bring more comprehensive care management, there was acknowledgement that a previous transition of seniors with complicated cases who went through a similar transition in 2011 experienced a bumpy ride.

California is even having a hard time retaining some Medicaid managed care contracts with providers who want to keep the clients but can’t come to terms. Health Net and 2 University of California medical centers this week announced that contracts will end as of January 1, 2015, affecting 4300 patients in the San Diego and Sacramento areas.

Affected patients will receive letters telling them they will have to find new doctors, but there won’t be much time to do so, and the market is already saturated with Medi-cal clients. In fact, medical residents at UC Davis organized a petition protesting the decision on behalf of patients they fear will be left without a doctor at the end of the month.

The decisions affect 3700 patients in Sacramento County and 600 in San Diego County, according to Health Net officials quoted in published reports.

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