March 25, 2013
Area(s) of Interest: Access to Care Patient Care
The Department of Health Care Services (DHCS) began transitioning approximately 860,000 low income children from the Healthy Families program into Medi-Cal Managed Care on January 1, 2013. Phases 1C and 2 of the four-phase transition will begin on April 1. Phases 1A and 1B are already underway.
The first two phases will affect children who are covered by health plans that participate in both the Healthy Families and Medi-Cal managed care programs in their counties of residence. These children will continue to be covered by their current plans. Children in all four phases will receive advance notice of their transition to the Medi-Cal managed care program. Children in phase 1 will receive a 60-day notice and children in phases 2-4 will receive a 90-day notice in advance of the effective date that will include more details about the transition, covered benefits under Medi-Cal and their health plan options, as well as information on who to contact for assistance.
Phase 1 – Part A began on January 1, 2013, and affects Alameda, Orange, Riverside, San Bernardino, San Diego, San Francisco, San Mateo and Santa Clara counties. Part B, which impacts Contra Costa, Fresno, Kern, Kings, Los Angeles, Madera, Monterey, Napa, Sacramento, San Diego (Health Net), San Luis Obispo, Santa Barbara, Santa Cruz, Solano, Sonoma, Tulare and Yolo counties, began in March 2013. Part C will begin on or after April 1, 2013, and affects Health Net plans in Kern, Los Angeles, Sacramento, San Diego, San Joaquin, Stanislaus and Tulare counties.
Phase 2 – Approximately 269,000 children will be transitioned in Phase 2, which is scheduled to begin on or after April 1, 2013.
Phase 3 – This phase will impact approximately 126,000 children who are covered by health plans that do not participate in Medi-Cal managed care or subcontract with a Medi-Cal managed care plan. These children will be enrolled in a Medi-Cal managed care health plan in their county of residence. Enrollment will include consideration of the child’s primary care providers. Phase 3 is scheduled to begin on or after August 1, 2013.
Phase 4 – This phase will impact approximately 42,000 children residing in counties that currently do not participate in Medi-Cal managed care. These children will be moved into the Medi-Cal fee-for-service system. If the state is successful in expanding Medi-Cal managed care statewide, these children will at that time move into managed care plans. Phase 4 is scheduled to begin on or after September 1, 2013.
DHCS welcomes feedback on the transition efforts. Questions or comments can be directed to DHCSHealthyFamiliesTransition@dhcs.ca.gov.
CMA will provide more information on the transition as it becomes available. Additional details, including answers to frequently asked questions, are available online at www.dhcs.ca.gov/services/Pages/HealthyFamiliesTransition.aspx.