Care coordination for older adult "dual eligibles": Early lessons from Cal MediConnect

The Helping Older-adults Maintain independencE (HOME) project has been documenting the experiences of low income older adults with multiple chronic conditions and disability in California since 2010.  In recent months, these “dual eligible” seniors (who are insured through both Medicare and Medicaid) have been faced with important decisions about the delivery of their medical care and long term services and supports. As part of California’s Coordinated Care Initiative (CCI), starting on April 1, 2014, an estimated 400,000 dual eligible beneficiaries in eight counties will begin to be enrolled in a MediCal managed care program called Cal MediConnect unless they actively opt out of the program. Recent data from the HOME project reveal that those who will be directly affected by the transition are often confused or concerned about its potential effects on their health care.  This vulnerable group of consumers is unevenly responsive to the program information received, depending in large part on the older adult’s physical or mental state and on the availability of family or other supportive resources. In-depth and repeated interviews conducted with these older adults and their primary caregivers also reveal what “continuity of care” actually means in the day-to-day lives of these individuals, who have been grappling in recent years with ongoing changes to the services, supports and providers they have come to rely on to continue to live safely at home. Finally, these data assess in “real time” whether any current gaps in care might be successfully addressed by the new managed care program.