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§1115 Waiver Update: Transitioning SPDs to Managed Care

This morning, the Waiver Implementation Stakeholder Advisory Committee held its quarterly meeting in Sacramento (agenda). Staff from the Department of Health Care Services (DHCS) provided updates on the transition of Seniors and Persons with Disabilities (SPDs) into managed care, the Low Income Health Program (LIHP), California Children’s Services (CCS) pilot programs, and coordinating care for Dual Eligibles. Toby Douglas, DHCS director, let participants know that 2012 SAC meetings will also focus on California’s implementation of federal health reform.

Jane Ogle, Deputy Director for Health Care Delivery Systems, provided an update on the transition of SPDs into managed care. The one-year transition involves 380,000 SPDs across 16 counties in California. DHCS found that, according to anecdotal reports, the transition is going smoothly. Phone interviews with members in across six plans revealed overall satisfaction with the transition. Stakeholders at the meeting refuted this point, arguing that they have experienced a series of difficulties throughout the process regarding disruption of care, defective forms, etc.

DHCS is finding the number of dual eligibles transitioning to managed care is also increasing. This is likely a result of the closing of Adult Day Health Centers (ADHCs) and the transition of the dual eligibles to managed care starting October 1. Approximately 80% of the 38,000 ADHC beneficiaries are dual eligibles.

Transition counties have been enrolling 23,000-24,000 SPDs per month until October, when enrollment dipped to approximately 19,000. They believe a large number of individuals who were originally deemed eligible were not. These individuals were only eligible for Share of Cost and not full-scope Medi-Cal.

DHCS has been able to increase the number of members they can link to previous providers (either primary or specialty care) for SPDs who default rather than select a provider. Linking is a new concept to DHCS and it took them a while to get it going. In June, they were only able to link 15% of members and in October, they linked 33%. Overall, members who maintained continuity of coverage (either chose a plan or were linked) increased from 52% to 72% in four months.

Since five counties have been awarded funds to do four CCS pilot programs, DHCS will now begin transitioning CCS children in non-pilot counties to managed care.

News on LIHP, CCS and duals will be up shortly!

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