On July 1, the California Department of Health Care Services (DHCS) released for stakeholder comment a Draft Voluntary Enrollment Strategy for 2016 for Cal MediConnect, the state’s dual eligible demonstration project. The strategy focuses on the following areas:

Beneficiary Outreach

  • Improved materials to support beneficiaries and their providers and caregivers in the decision-making process.
  • Streamlined enrollment so that beneficiaries can enroll in the Cal MediConnect product associated with their current Managed Long-Term Services and Supports (MLTSS) plan.
  • Instead of passively enrolling beneficiaries currently eligible for Cal MediConnect who are not currently enrolled in MLTSS or Cal MediConnect plans, DHCS will mandatorily enroll them into MLTSS plans no sooner than September 2016.
  • Potential informational mailings to beneficiaries in Fall 2016.
  • Conducting tele-town halls to share updates with homebound beneficiaries and those beneficiaries with disabilities.

Provider Outreach

  • DHCS and Cal MediConnect plans will conduct outreach to providers with high opt-out rates.
  • DHCS will partner with health plans and stakeholders to draft a variety of toolkits for specific groups of providers, including behavioral health providers and social workers. Currently, there is a Physician’s Toolkit and recently, in partnership with California Hospital Association and Cal MediConnect health plans, DHCS developed the Cal MediConnect Hospital Case Manager Toolkit, a new resource to support Cal MediConnect enrollees before, during and after hospitalization.
  • DHCS will conduct outreach to non-participating providers, providers serving ethnically and culturally diverse communities and other types of providers such as LTSS providers.


Hospitals in Maryland have banded together to create a new campaign designed to  />highlight for consumers how hospital care in the state is changing. The Maryland Hospital Association, with support from consumer health advocates as well as the AARP, NAACP and others, has launched the <a href=Breath of Fresh Care Campaign, the goal of which is to encourage patients to engage more robustly in their health care so as to encourage coordination and prevent complications.  

 “Most Marylanders don’t realize what a significant change there has been in how health care is delivered,” said Vincent DeMarco, president of the Maryland Citizens’ Health Initiative (pictured at the event launching the new campaign). “Hospitals in Maryland more than anywhere else are putting resources into population health and working with the community in ways they didn’t before.”

Maryland hospitals are now paid using a global budgeting model, which incentivizes them to seek improvements in care to reduce preventable hospitalizations and related complications.


On July 1, the Commonwealth issued a request for responses (RFR) for a third-party administrator (TPA) to assist the state in managing the administration and delivery of fee-for-service long-term services and supports (LTSS) under MassHealth, the state’s Medicaid program. About 250,000 MassHealth members use LTSS under a variety of delivery models, including fee-for-service, managed care organizations, Senior Care Options, the Program of All-Inclusive Care for the Elderly (PACE) and One Care, the state’s dual eligible demonstration project. The state intends to award a single statewide contract for an initial three-year term from Jan. 1, 2017, through Dec. 31, 2019, with the option of two additional extension years. Responses are due on Aug. 15, 2016.

In other news, Health Care for All in Massachusetts hosted its Fourth Annual Patient and Family Advisory Council (PFAC) Conference, which provided PFAC members with a daylong opportunity to network with one another and share best practices, challenges and successes related to meaningfully engaging through membership on a PFAC. A Community Catalyst  blog post captures some of the highlights of the conference.

New York

As the state of New York has moved aggressively to shift its health care system to value-based payment arrangements, Clinical Advisory Groups (CAGs) were established to develop quality measures to go along with these new payment arrangements. The CAGs on behavioral health, HIV/AIDS and maternity care have completed their recommendations and their reports have been posted for public comment. Comments are due by July 24.


The Oregon Health Authority Office of Health Analytics released a 2014 Oregon Hospital Payment Report – the first in an annual series that uses data from Oregon’s All Payer All Claims Database to provide a source of transparency and public accountability for hospital prices. As of last year, Oregon began mandating the annual public reporting of median payments from commercial insurers to hospitals for common inpatient and outpatient procedures in an effort to control the growth of health care costs through transparency and accountability. Using the measure of median paid amount, most procedures show sizable variations across the state, as listed graphically by hospital or medical center name. Among common outpatient procedures, gallbladder surgery is the most expensive with a median paid amount over $9,000; for common inpatient procedures, heart valve replacement surgeries were the most expensive with a median paid amount over $74,000; the most common procedure paid for by commercial insurance companies is mammograms, with over 86,000 paid claims in 2014.


The Pennsylvania Health Access Network, in partnership with the Housing Alliance of Pennsylvania, the Pennsylvania Health Law Project and Project HOME recently hosted roundtable discussions in Harrisburg and Pittsburgh on Medicaid and Supportive Housing Services. The events were part of the Pennsylvania advocates’ Housing as Health campaign which has brought together a statewide coalition of health advocates and housing-related entities that are advocating for Medicaid in Pennsylvania to cover more supportive housing services for consumers with either a physical or behavioral health condition.

South Carolina

The South Carolina Department of Health and Human Services  announced that Advicare is exiting the state’s dual eligible demonstration project, impacting about 3,650 members. Members currently covered by the Advicare Advocate dual plan have until Aug. 30, 2016 to choose another plan or return to fee-for-service Medicaid. After that they will be passively enrolled in another plan.