Home » Blog » Healthy Families Program Transition to Medi-Cal Webinar August 21, 2012

Healthy Families Program Transition to Medi-Cal Webinar August 21, 2012

The Webinar included a series of updates from State agencies involved in the Healthy Families Program (HFP) transition to Medi-Cal. A PowerPoint presentation was emailed to Webinar participants.

Katie Johnson (Consultant, CHHS) reviewed the goals of the transition:

  • Facilitating a smooth transition
  • Minimizing disruption in services
  • Maintaining eligibility gateways
  • Ensuring access to care
  • Ensuring continuity of care

Toby Douglas (Director, DHCS) summarized the four phases of the transition.

  • Phase 1 (January 1, 2013): 411,654 children enrolled in a HFP health plan that is a Medi-Cal managed-care health plan (MCHP) shall be enrolled in the same plan
  • Phase 2 (April 1, 2013): 261,060 children enrolled in a HFP health plan that is a subcontractor of a Medi-Cal MCHP will be enrolled into a Medi-Cal MCHP that includes the individuals current plan
  • Phase 3 (August 1, 2013): 152,602 children enrolled in a HFP plan that is not a Medi-Cal MCHP and does not contract or subcontract with a Medi-Cal MCHP will be enrolled in a Medi-Cal MCHP in that county. Enrollment will include consideration of the individuals’ primary care providers
  • Phase 4 (September 1, 2013): 42,753 children residing in a county that is not a Medi-Cal managed care county shall be provided services under the Medi-Cal fee-for-service (FFS) delivery system

Janette Casillas (Executive Director, MRMIB) provided an update on their progress:

  • To ensure successful patient notification, a series of notices are being distributed by HFP and Medi-Cal. HFP will issue general notices at 90-days, 60-days, 30-days before transition. Medi-Cal will provide welcome and introduction to Benefits Identification Card (BIC) notices when transitioning. A draft General Transition Notice was emailed to Webinar participants.
  • The notices will be provided in Medi-Cal threshold languages and are to be reviewed by the Center for Health Literacy to ensure appropriate reading level.
  • Call center messaging is being done by HFP, DMHC, and DHCS

Maureen McKennan (Deputy Director, Plan and Provider Relations DMHC) discussed pre- and post-implementation standards:

  • Pre-implementation
    • DMHC is working to ascertain network advocacy (per plan, per county)
    • DMHC has submitted a coordinated data request to plans to assess provider overlap and capacity
    • DHCS will develop a database of providers in counties by finding which primary care providers (PCPs) will accept new patients and which PCPs will keep existing patients after the transition
    • DHCS is working to ensure continuity of care
  • Post-implementation
    • Monitoring network adequacy and access through enrollee complaints and plan surveys
    • Monitoring continuity of care by reviewing complaints
    • Monitoring financial solvency of health plans, and delegated medical groups and compliance with Knox-Keene Act

Robert Suguwara (Chief, Medi-Cal Eligibility Division, DHCS) provided an update on eligibility and enrollment processes:

  • Two All County Welfare Director Letters (ACWDLs) were released July 27 for county stakeholders to review and submit comments
  • There will be five new aid codes: 2 for HFP transition children and 3 for the new enrollees into Medi-Cal
  • No premiums for children with family income up to 150% of FPL
  • Maximus will notify families with income between 150 and 200% of FPL who will pay a small premium:
    • $13 for one child, $26 for two children and $39 for 3 or more children
  • DHCS has developed workgroups for stakeholder engagement including a Technical workgroup focused on family notification and information; a County Performance Standards workgroup tasked to measure performance on 10-day disenrollment and accelerated enrollment processes; and a Reporting workgroup to develop reporting requirements
  • Children in the Medi-Cal Share of Cost Program will not be affected by redetermination process because assets are not considered in this new expansion population

Javier Portella (Medi-Cal Managed Care Division, DHCS) discussed readiness of the Medi-Cal Managed Care Plans:

  • Vision services will no longer be provided at FFS rates but will be contracted through Medi-Cal managed-care plan vision provider in each county
  • DMHC will inform counties on various phases on transition

Alicia Sippin (Dental Program DHCS) provided dental plan updates:

  • Dental services will be transitioned with medical services
    • 56 counties will change to Denti-Cal FFS, while Los Angeles and Sacramento will remain in Dental Managed Care plans
  • Assessing dental plan readiness through contract amendments, performance standards and network adequacy
  • Monthly stakeholder meeting for dental managed care will be held in LA and Sacramento

Erika Cristo (Behavioral Health, DHCS) provided update on mental health services, main points included:

  • In Medi-Cal Managed Care counties, non-specialty mental health services will be provided by the Medi-Cal Managed-Care Plan; for services not covered by the plan, patients can see a Medi-Cal FFS provider
  • In non-managed care counties, Medi-Cal providers provide non-specialty MH services
  • County Mental Health Plans (MHPs) will be responsible for all specialty mental health services
    • Former HFP enrollees that meet medical necessity criteria will have access to EPSDT services through MHPs
  • County MHPs will continue to provide services for children that meet medical necessity criteria for Medi-Cal Specialty Mental Health Services.  However former SED criteria will no longer apply, and new criteria will have to be developed.

Maria Volk (Vaccine Management and Field Services, DPH) provided an update on the Statewide Vaccines for Children Program (VCP):

  • Medi-Cal can purchase vaccines at federal level wholesale prices, which will be far more cost effective than the competitive rates HFP purchased vaccines for in the past
  • DPH is surveying existing provider networks for the number of children to transition to update the vaccine orders
  • New providers will have a 4-6 week process of enrollment
  • VCP is a federal entitlement program so there is no cap on the number of vaccines that can be provided as long as patients are put into the registry.

Katie Johnson (Consultant, CHHS) reviewed next steps in the transition. She referenced the timeline to inform about upcoming stakeholder meetings and discussed key questions for consideration.

Representatives emphasized the need for stakeholder input and feedback on measures of the transition (i.e., phases in schedules, notices, outreach, and strategic plan framework). The key questions for stakeholder consideration include:

  • Should phase-in schedule occur based on the four phases outlined in statute or on a different schedule throughout 2013?
  • How many notices should be provided to individuals prior to their transition phase in addition to what is outlined in the statute?
  • What strategies would you envision DHCS to undertake to ensure information is disseminated and families are fully informed?
  • What is the best way to engage for stakeholder review and feedback?

Stakeholder questions and comments included:

  • Information collected by DHCS and MRMIB on provider networks should be made available via DHCS website
  • County workers will perform redetermination for Medi-Cal children
  • The managed-care delivery system monitors and enforces access to care for health and dental services
  • Premiums for the program are set in Medi-Cal statute and cannot be amended by counties
  • Some enrollees will have nominal copays for non-emergency services that range from $1-$5 but are non-enforceable
  • Families are granted up to two months of non-payment before being dis-enrolled from the program

 

 

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