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Waiver Update: Summary of 9th DHCS Stakeholder Advisory Committee Meeting

The ninth Stakeholder Advisory Committee meeting on the 1115 Waiver was held this morning in Sacramento. Participants included representatives from CCS, CCHA, BSCF, Health Access, LACDHS, LADMH, Open Door Community Health Centers, Anthem Blue Cross, AARP, Molina, CHLA, CHCF, CPCA, and IEHP, among others.

Toby Douglas, DHCS director, announced that we are now moving from the planning phase of the waiver to the implementation phase.


Below are links to some great handouts I picked up on the Low Income Health Program (LIHP).

This one is a county-by-county breakdown of income limits, first year enrollment projections, and anticipated expenditures.

This one is a LIHP program timeline.


Sixteen counties began mandatory enrollment of approximately 380,000 SPDs into managed care today. Outreach to SPDs with May births (with scheduled enrollment for June 1) included the following:

90-day enrollment upcoming change notice: 30,230 mailed
60-day enrollment packets: 29,532 mailed
30-day reminder: 19,908 mailed

Data indicates that when a mandatory managed care program begins, the ratio of those who choose a plan to those who default is 30:70 (consistent with DHCS results). Within a year, this number usually flips to 70:30. Given the June birth month enrollees are already responding faster than the May ones did, DHCS estimates this flip will occur by June 1, 2012. DHCS believes that the reason 14.76% less enrolled than were eligible could be due to eligibility issues such as those who qualify for dual status (Medi-Medis).

Number enrolled who chose plans: 7,976 (31%)
Number enrolled who were defaulted: 17,792 (69%)
Total enrollees: 25,768 (14.76% less than those originally notified)

DHCS attempted to link enrollees who defaulted to their usual source of care, including primary care providers or clinics. They were only able to link 8% and are analyzing the reason for this low number, such as interfacing with plans, in order to find ways to increase it. They found that 20-22% of those they had to default had no utilization data. Participants mentioned that changing doctors is not always a negative outcome because it allows the patient to establish a new medical home. In addition, enrollees who prefer a specialist as their medical home might not have been aware that this was a possibility.

Linked to previous provider: 1,411 (8%)
Default assigned: 16,381 (92%)

DHCS mentioned that they are very open to making necessary adjustments as this program rolls out, starting with updating the 14-year-old enrollment packet.