California’s Cal MediConnect demonstration to integrate and coordinate healthcare for individuals dually eligible for Medicare and Medicaid will not move forward as planned in one of eight pilot counties. The Centers for Medicare and Medicaid Services (CMS) performed a performance audit of the sole insurer selected for the duals demonstration in Orange County and found numerous problems. Orange County has the second largest population (57,000) of dually eligible individuals in the state. The demonstration is to begin April 1 in the remaining seven counties.
CMS approved the Kansas 1115 Waiver Amendment allowing the state to provide long term supports and services (LTSS) to individuals with intellectual and developmental disabilities (I/DD) through managed care. Kansas contracts with three for-profit health insurance companies for the delivery of all Medicaid services. The Kansas legislature delayed the inclusion of I/DD long term services and supports (LTSS) for one year after the start of KanCare, the Kansas managed care program. CMS imposed an additional one-month delay on the start of KanCare for I/DD LTSS due to questions it had about the program, including concerns about individuals receiving some but not all of the waiver services they need. Kansas is the first state to use private health insurers as managed care organizations for managed LTSS for individuals with I/DD.