Modern Healthcare interviewed L.A. Care in "CMS may start cracking down on dual-eligible 'look-alike' plans". The piece talks about the federal government's plan to promote more integrated care for patients eligible for both Medicare and Medicaid, and consequently crack down on dual-eligible special needs (D-SNP) plan "look-alikes".
D-SNP look-alikes are designed and marketed to attract dual-eligible patients, who may enroll thinking they will receive integrated Medicare and Medicaid benefits and extra care coordination. Instead, they find themselves in general Medicare Advantage plans without the ability to integrate with Medicaid and miss out on benefits they could receive elsewhere, critics argue.
"Members are not going to get the same level of care; they are not going to get the care coordination that they get in the fully integrated plan," said John Baackes, CEO of L.A. Care, which serves 16,000 dual-eligible members in California's Medicare-Medicaid demonstration plans. "So we are very concerned about them and looking for ways we can advise CMS and the state on ways they can isolate these programs so they are sold for what they are and not what they pretend to be."