Managed Care in California


DREDF submitted comments on the updated California State-Specific Reporting Requirements for Contract Year 2015, released by the Centers for Medicare and Medicaid Services (CMS) June 22, 2015. (June 29, 2015)

We applaud CMS for incorporating additional needed specificity in its reporting requirements for physical access compliance and recommend strengthening the provision by, among other things, including year-to-year and reporting requirements for programmatic access.

DREDF comments on proposed rule concerning Medicaid, Children’s Health Insurance Programs; Mental Health Parity and Addiction Equity Act of 2008; the Application of Mental Health Parity Requirements to Coverage Offered by Medicaid Managed Care Organizations, the Children’s Health Insurance Program (CHIP), and Alternative Benefit Plans, RIN 0938-AS24 (PDF). (June 9, 2015)

We strongly support the proposed rule’s foundational premise that mental parity for Medicaid MCO enrollees applies across mental health service delivery systems, without regard for limitations in state Medicaid plans.

DREDF Comments on Draft Health Risk Assessment Health Plan Guidance for California’s Duals Demonstrations (PDF). (May 2, 2013)

We present our concern about the potential conflicting interests and inconsistencies of the processes describing the implementation of the Health Risk Assessment.

DREDF expresses deep concerns about California’s plans to integrate Home and Community Based Services (HCBS) in the Coordinated Care Initiative (PDF). (February 24, 2013)

We present our concern that the proposed policy will restrict the scope, amount, and duration of HCBS to managed care plan members.

DREDF Recommends Accessibility Related Network Readiness Review Criteria (PDF). (October 5, 2012)

We identify key accessibility criteria for ensuring readiness of managed healthcare and other provider networks to serve a large number of people with disabilities and seniors.

DREDF comments on California’s Dual Eligible Demonstration Coordinated Care Initiative (PDF). (May 8, 2012)

We raise the concern that DHCS plans to delegate responsibility to the plans for implementing and managing the demonstration when the Department, itself has identified foundational weaknesses in many of the plans’ capacity to work effectively with seniors and people with disabilities.

California HealthCare Foundation report, Transitioning the SPD Population to Medi–Cal Managed Care (March 28, 2013)

Silvia Yee testifies on report findings.
The hearing presents early research findings for the transition experiences of beneficiaries.

Identifying and Selecting Long-Term Services and Supports Outcome Measures (PDF) (January 2013)

A guide for advocates researched and written by Mary Lou Breslin, Senior Policy Advisor, in collaboration with the National Senior Citizens Law Center (NSCLC).

This paper provides resources to help state advocates identify quality measures that can help determine if the identified needs and goals of people with disabilities and seniors are being met as more states launch initiatives to provide Medicaid Long–Term Services and Supports (LTSS) — including both institutional and Home and Community–Based Settings (HCBS) — through managed care arrangements.

WEBINAR: Managed LTSS: Engaging in the Stakeholder Process. (June 27, 2012)

Silvia Yee, DREDF Senior Attorney and Mary Lou Breslin, Senior Policy Advisor along with Georgia Burke, Directing Attorney, National Senior Citizens Law Center presented the webinar on behalf of the Administration for Community Living (ACL).

The webinar introduces strategies for stakeholder engagement on topics including person centered planning, care continuity, provider choice and access, care transitions, and infrastructure capacity as more states move to managed LTSS.

WEBINAR: Long—Term Services and Supports in a Managed Care Environment. (June 11, 2012)

Silvia Yee, DREDF Senior Attorney and Mary Lou Breslin, Senior Policy Advisor along with Georgia Burke, Directing Attorney, National Senior Citizens Law Center presented the webinar on behalf of the Administration for Community Living (ACL).

The webinar introduces 15 areas of consumer protection that are necessary when long-term services and supports are provided in a managed care environment.

DREDF and NSCLC Launch the Toolkit, Long-Term Services and Supports: Beneficiary Protections in a Managed Care Environment

A growing number of states are proposing to place the responsibility for providing long–term services and supports (LTSS) to seniors and people with disabilities under managed care organizations (MCOs). Strong beneficiary protections are required to ensure models that support independence and the ability of people with disabilities to remain in or return to community settings.

Advocacy Principles for the Dual Eligible Integration Policy Initiatives (PDF)

Adopted by DREDF, NCIL, Community Catalyst, and several Independent Living Centers