Health and Human Services (HHS) Secretary Kathleen Sebelius on Wednesday announced that California will partner with the Centers for Medicare & Medicaid Services (CMS) to test a new initiative to improve care for people enrolled in both Medicare and Medi-Cal (California’s Medicaid program).

Under the demonstration, California and CMS will contract with Medicare-Medicaid plans to be accountable for and coordinate delivery of covered services for participating enrollees, and offer them new services.  

About 456,000 Medicare-Medicaid enrollees in Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo and Santa Clara counties will have an opportunity to receive better, more coordinated care as a result of this new program.

“In California, we have a unique opportunity to forge a new pathway toward a better care experience for the beneficiaries we serve through both Medicare and Medicaid,” said Marilyn Tavenner, acting administrator of CMS. “Today’s announcement marks the beginning of a new effort to provide these Californians with more coordinated care that addresses their unique and individual care needs more effectively.”

The demonstration is designed to offer opportunities for beneficiaries to self-direct services, be involved in care planning, and live independently in the community.  

In addition to new dental, vision, and non-emergency transportation services, all beneficiaries in the demonstration will continue to have access to their existing Medicare and Medicaid benefits.  

California is one of a handful of states to launch a Financial Alignment Demonstration to coordinate care delivery across primary, acute, behavioral health, prescription drug, and long-term supports and services, to better serve Medicare-Medicaid enrollees.

The demonstration is the culmination of an extensive planning and development process through which Medicare-Medicaid enrollees, caregivers, advocates, and other stakeholders partnered with California and CMS to help shape the design of the new program.

Under the demonstration, Medicare-Medicaid plans will be responsible for working with enrollees and their caregivers to develop person-centered, individualized care plans. The team will be built on the enrollee’s specific preferences and needs.

Services will be delivered with transparency, individualization, respect, and linguistic and cultural competence. The demonstration also includes robust continuity of care requirements so that beneficiaries can continue to see their providers as they enroll in Medicare-Medicaid Plans.   

Plans and counties within the state are developing agreements to facilitate integration of In-Home Supportive Services and behavioral health in the demonstration.

CMS will measure quality including the beneficiary’s overall experience of care, level of care coordination, beneficiary care transitions, and the support of community living in California.  

CMS also will support a rigorous independent evaluation of both the quality of care received by participants, as well as any impact the demonstration has on Medicare and Medicaid costs.

To learn more about the California-CMS partnership and to see proposals submitted by other states, visit http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialModelstoSupportStatesEffortsinCareCoordination.html .