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An Initial Report on Mandatory Enrollment of Medi-Cal’s Seniors and People with Disabilties into Managed Care

The California Healthcare Foundation (CHCF) recently released a report examining health plans’, providers’, and stakeholders’ experiences during Medi-Cal’s mandatory transition of seniors and people with disabilities to managed care as a part of California’s “Bridge to Reform” 1115 waiver. The managed care expansion primarily affected 240,000 beneficiaries in 16 counties who were not already enrolled in managed care. They were required to enroll in a managed care plan, or they were assigned to one.

The federal government approved the waiver in November 2010, and DHCS sent notices of the transition to beneficiaries four months later. DHCS enrolled an initial group of beneficiaries into managed care plans in June 2011, and the last group transitioned in May 2012. Before and throughout the transition process, the Department of Health Care Services (DHCS) and its enrollment contractor worked closely with managed care plans and stakeholders and held informational meetings for beneficiaries throughout the state. However, many stakeholders and plans reported experiencing difficulties during enrollment.

Stakeholders indicated that beneficiaries did not understand informational materials that DHCS made available about the transition. While DHCS and contracted health plans held many informational meetings, fewer than half of the managed care plans offered individual counseling or support to transitioning beneficiaries. Stakeholders also felt that care coordination and support services should have been offered to beneficiaries earlier in the process, rather than at the time when beneficiaries were enrolled and seeking care. Moreover, some stakeholders felt that plans were not prepared to handle the population’s complex and elevated care needs.

Health plans reported that beneficiary contact information was outdated or not accurate. Plans also reported difficulty recruiting providers and obtaining information about durable medical equipment and pharmacy providers. Providers felt that they did not receive information about their new patients in a timely fashion.

The CHCF report also noted that DHCS did not define any performance goals for the transition. As a result, remains difficult to assess the effectiveness or success of the policy change and the enrollment process.

Based on these findings, the authors of the report made several recommendations :

-A managed expansion of this scope requires a longer planning period

-Improve communication with beneficiaries regarding Medical Exemption Requests and disruptions in continuity of care; make informational materials accessible for people with disabilities by providing them in alternative formats; seek feedback from stakeholders about these processes and materials

-Conduct more extensive provider outreach and forward needed patient information to health plans

-Develop outreach, engagement, and care management and coordination functions before enrolling new beneficiaries, and target these services to high-volume users of services

-Consider a grace period after enrollment or auto-assignment to plans

-Establish performance benchmarks, particularly with respect to utilization, patient satisfaction, and health outcomes

 

For the full report, click on the link here:

A First Look: Mandatory Enrollment of Medi-Cal\'s Seniors and People with Disabilities into Managed Care A First Look: Mandatory Enrollment of Medi-Cal\'s Seniors and People with Disabilities into Managed Care.pdf

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