Medi-Cal and Medicare: dual eligible beneficiaries: special needs plans.
AB 1230 is expected to address the integration of healthcare services for the dual eligible population more effectively. With this bill, beneficiaries will have the option to select from multiple available health plans that meet specific quality metrics, allowing them to continue their relationship with established healthcare providers. Notably, the bill mandates that contracting plans perform necessary care coordination and data-sharing functions to facilitate comprehensive care integration, thereby improving patient outcomes and reducing hospitalizations.
Assembly Bill 1230, introduced by Assembly Member Valencia, aims to enhance the care for individuals eligible for both Medicare and Medicaid services, referred to as dual eligible beneficiaries. The bill focuses on creating Highly Integrated Dual Eligible Special Needs Plans (HIDE-SNPs) and Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs) that will be contracted starting January 1, 2025. This legislative effort acknowledges that California has over 1.6 million dual eligible individuals who often experience greater health disparities and significant chronic health issues, making them high-cost enrollees in both programs.
There may be some concerns surrounding the implementation of HIDE-SNPs and FIDE-SNPs, particularly regarding their effectiveness in addressing the unique needs of dual eligible beneficiaries. Critics could argue that establishing these specialized plans must ensure that they do not inadvertently restrict patient choices or access to care. Additionally, discussions around funding and administrative capabilities for such a broad initiative might arise, especially given the substantial costs associated with dual eligible beneficiaries, who account for a disproportionate share of Medicare expenditures.