CMS and Duals in 2014

[policy doctor]

Just left a meeting for a new mapd in area and was told that CMS will auto enroll duals into a managed plan starting Jan 2014. If a dual is already a member of another plan, or prefers another plan, the member has to OPT out of the plan chosen by CMS. (like those credit cards)

WTH....I don't have a large book of dual business....about 20...but I sure don't want to lose what I worked for. They said or cited a Georgia Medicaid piece of legislation where this was inserted...I have to find it but I'll do this later, not now. This being enacted in other states.

Can anyone else testify to this? But see, another way the gov't is circumventing the agent. All you can hope for is the commission you earned this year...don't bank on the renewals. I'm so ticked.

 

[tins]

Just left a meeting for a new mapd in area and was told that CMS will auto enroll duals into a managed plan starting Jan 2014. If a dual is already a member of another plan, or prefers another plan, the member has to OPT out of the plan chosen by CMS. (like those credit cards)

WTH....I don't have a large book of dual business....about 20...but I sure don't want to lose what I worked for. They said or cited a Georgia Medicaid piece of legislation where this was inserted...I have to find it but I'll do this later, not now. This being enacted in other states.

Can anyone else testify to this? But see, another way the gov't is circumventing the agent. All you can hope for is the commission you earned this year...don't bank on the renewals. I'm so ticked.

Rick told me that Cali has been doing this for a year or so now.
Said it has resulted in a lot of new business because Duals are now more aware that these plans exist.

 

[policy doctor]

Well since the network is the same for all....a Medicaid approved providers...then the only competition is on value added benefits, right?

Some may prefer one company name over another, but the chassis is the same for all.

 

[honestagent]

WTF....?!?!??!?!

Is your source sure?

That does NOT sound right; but with Obamacare, who knows -that could be a hidden and known to fact/change.


I'll make some calls.

 

[tins]

Well since the network is the same for all....a Medicaid approved providers...then the only competition is on value added benefits, right?

Some may prefer one company name over another, but the chassis is the same for all.

Exactly.
So, if you walk in there and are the one that signs them up, should be easy business (that will stay on the books since they have to be on a plan) and most of it will be tru-up business in the beginning.
Could be a massive boon to business for experienced agents over there.

 

[sman]

Just left a meeting for a new mapd in area and was told that CMS will auto enroll duals into a managed plan starting Jan 2014. If a dual is already a member of another plan, or prefers another plan, the member has to OPT out of the plan chosen by CMS. (like those credit cards)

WTH....I don't have a large book of dual business....about 20...but I sure don't want to lose what I worked for. They said or cited a Georgia Medicaid piece of legislation where this was inserted...I have to find it but I'll do this later, not now. This being enacted in other states.

Can anyone else testify to this? But see, another way the gov't is circumventing the agent. All you can hope for is the commission you earned this year...don't bank on the renewals. I'm so ticked.

Which carrier? I don't do any Dual business so it's not going to impact me. Just curious as to who the carrier is.

On the same topic, I thought Duals were automatically enrolled in PDP plans? Wouldn't enrolling them in a MAPD automatically disenroll them from their PDP? Of course I know the answer to that. The point I'm making is how many Duals are going to get screwed up because they had a PDP and were perfectly content with that set up only to be moved to an MAPD? And how many aren't going to realize their plan was changed until they go to get a prescription filled in January?

 

[policy doctor]

SMAN:
You know everyone is pushing Cigna/Healthspring hmo here.

We went to mooch the free lunch. OK.. I don't need another hmo....but I did learn many new things, how ma's are losing money if their folks are healthy, the importance of star rating, rising costs, blah, blah but my ears perked on what I posted.

I remembered a post that some UHC dual plans were going away in some areas...maybe this is a reason?
Will cms bump existing business to their state plan...that would destabilized plans with carriers so maybe not. Surely same co's will remain in this line. OK..then what? Do they(state) mail out a generic letter to all duals touting their endorsed plan which will confuse or pressure client to change...don't know. Just stay in touch with your people so they call you if they get auto-assigned.

 

[fleur]

Of the few dual clients I do have, all through this past year they have received strongly worded letters from Medi-Cal that said "you will choose one of two plan listed. If you do not, we will auto enroll you within 30-60 days."
Clients were flipping out, not wanting to loose the plan of their choice, providers, extra value benefits etc.

Now the wording (below) states voluntary, option to choose, opt out.......but take note of the last paragraph.




The state of California is launching a dual demonstration program as of January 2014. Through its contracted partners, the state will begin enrolling full dual eligible beneficiaries in the following eight counties.

Northern California Counties;

Alameda
Santa Clara
San Mateo


Southern California Counties;

Los Angeles
Orange
Riverside
San Bernardino
San Diego


Background on the Dual Demonstration Program

The Dual Demonstration Program, referred to as Cal MediConnect, was born out of the Coordinate Care Initiative enacted in July 2012. It is a voluntary three year demonstration aimed to improve care coordination for full dual eligible beneficiaries and to drive high quality care.

California has about 1.1 million dual eligible beneficiaries. Cal MediConnect targets beneficiaries who qualify for both Medicare and Medi-Cal public health insurance programs.

Beneficiaries who are eligible to enroll in Cal MediConnect, and are not enrolled in a Medicare Health Plan, will be passively enrolled in a Cal MediConnect health plan within their county. Beneficiaries have the option to choose a plan or opt out of Cal MediConnect and remain on Medicare fee-for-service or join a qualifying HMO Special Needs Plan.

It is very important to understand that opting out applies only to Medicare benefits, but the beneficiary must still get their Medi-Cal Benefits through a designated Managed Care Health Plan for each of the eight counties listed above.

 

[midwestbroker]

KS has 3 managed care plans for anyone on Medicaid (underage as well). This has been going on since about Jan of this year. If they do not pick one, they are auto enrolled.

Been a mess.

 

[policy doctor]

I had a CMS link for this and darn if I didn't lose it. However, google search will bring up several articles concerning this....just type in as header above.