New America Media

“Watch for the blue envelope—Don’t throw it away!”

That’s the message community reporters need to spread, San Diego’s leading health care directors urged at a recent briefing of local media and frontline health care practitioners and advocates organized by New America Media. The county’s health leaders are working to implement a new federal and state program to improve care for almost a half million low-income seniors and people with disabilities, almost 50,000 of them in San Diego.

The blue envelopes began arriving on Jan. 1, and thereafter in 30 day intervals up to (April 1, when San Diego is scheduled to launch Cal MediConnect, a pilot program that seeks to merge services for beneficiaries of both Medi-Cal (California’s name for the low-income Medicaid program) and Medicare.

Minimizing costly health emergencies

These so-called “dual eligibles” often have complicated health care, made especially costly because their treatment is fragmented among different providers and systems, causing them to end up unnecessarily in emergency rooms and hospitals.

The new Cal MediConnect pilot program aims to coordinate the care of dual-eligible patients into one care-management program.

Inside the blue envelope is a letter explaining the new program and inviting beneficiaries to select one of five health care plans that have signed on to provide coverage in San Diego. Failure to respond by May 1, means they will be “passively” (automatically) enrolled in one of the programs. That could make it difficult to retain their current care providers or the medications or vendors they rely on that may not be covered by a particular health plan.

Although all dual-eligibles must join the Medi-Cal part of the managed care program, they can chose to opt out of the federal Medicare part of the program. Experts explained that some dual-eligibles may be tempted to opt out fearing they might lose their current doctor, but doing so would block the care coordination at the heart of the program. The good news is that the state can help patients retain their providers, even if they are not initially part of the approved care plans.

San Diego’s Cal MediConnect program is one of seven scheduled to roll out in California in 2014 and early 2015, with federal funding provided under the Affordable Care Act (ACA). Nationally, 21 states are participating in the duals-demonstration project or are proposing to do so.

Cal MediConnect “will transform patient care for the sickest, poorest and most vulnerable patients in our county,” said Gregory Knoll, director of San Diego’s Legal Aid Society.

More culturally fluent communication

“My husband might still be alive today if MediConnect had been in place while he was suffering from three successive strokes, and being shuttled between one facility and another,” said retired health educator Aurora Cudal, 80. For her husband, Winlove Cudal, who died last year at 88, there was “no one single supervisor for his care.”

A strong proponent of Cal MediConnect, Cudal, also a longtime columnist for the Filipino Press, worries that many elders in her community are still uninformed. If they’ve opened the blue envelope, they’re confused.

Cudal urged, “We need more culturally fluent communication, and people who’ll come speak to us to ease the fear that this means seniors will lose the doctors they trust.”

Pamela Hoye, an activist for people with disabilities who spoke through an interpreter, is also an enthusiastic supporter of Cal MediConnect, but she expressed concern that the managed care provided by teams of health care providers may be less responsive to the patients rather than to their own bureaucratic needs.

There will inevitably be glitches, noted Richard Butcher, M.D., medical director of San Diego’s Multi-Cultural Independent Physicians Association, who has provided care to dual-eligibles for many years.

Butcher, who is also chief of staff at Alvarado Hospital, said his office has already been overwhelmed by people seeking advice and referrals about the new program.

As long as someone is eligible for federal Medicare benefits, under ACA’s new rules, which started Jan. 1, San Diego provides all residents with access to Medi-Cal—except for undocumented immigrants, who are barred from benefits under federal law—who have incomes at or below 138 percent of the federal poverty level.

Under federal Medicare rules, however, permanent legal residents can qualify only if they have been in this country for at least five years and have earned (or their spouse has earned) 40 quarters (10 years worth) of credits for paying into the Medicare program. Cal MediConnect participants must also have full Medicare coverage under its Part A (hospital coverage), Part B (doctor’s care) and Part D (prescription drugs) programs.