Orange County Duals Face Changes in Healthcare Programs

It comes in the form of the new Cal MediConnect program which begins enrollment this week.

A “Dual” is an individual who qualifies for both Medicare and Medi-Cal. The new program seeks to improve care and coordination for these patients by combining the financing and services of the two programs.

Eight counties are currently participating in a demonstration project, with Orange County being one of the last to roll out the program after hitting a few problems along the way.

The only insurer currently participating in the OC is called CalOptima, who was recently sanctioned after failing a variety of aspects in a 2014 audit including providing required prescriptions and processing payments on time.

They have since reported to have resolved the issues.

Another one of the main concerns going forward for the OC is the patient opt out rate, as all duals will be enrolled in the program in a system of passive enrollment. Steps have been taken to smooth the transition of those already receiving long-term care.

Orange County has some 57,000 duals, the second most duals in the state after LA County.

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