January 14, 2013
Area(s) of Interest: Access to Care Payor Issues and Reimbursement Practice Management
On December 31, 2012, the Department of Health Care Services (DHCS) received federal approval to begin transitioning approximately 860,000 low income children from the Healthy Families program into Medi-Cal Managed Care. Phase 1A of the transition (see schedule below) began on January 1, 2013.
The transition, proposed by Governor Brown and passed by the Legislature last summer as part of a larger plan to close the budget deficit, is expected to save about $64 million this year. The California Medical Association (CMA) has opposed the plan since it was first proposed and believes the move will likely have a negative impact on those who rely on the Healthy Families program for health care coverage.
CMA continues to attend stakeholder meetings and will work closely with DHCS during the transition.
The Healthy Families program transition is scheduled for a four-phase roll out. 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.
Details of the four-phase transition are below. Please note the addition of phase 1C since our last report.
Phase 1 – More than 403,000 children will be transitioned in the first phase. This phase is divided into three parts. 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 will impact 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 and will begin on or after March 1, 2013. Part C will begin on or after April 1, 2013, and affects Kern, Los Angeles, Tulare, Sacramento, San Diego, San Joaquin and Stanislaus 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.
As with the beginning of a new year, we remind you to request new copies of enrollees’ membership cards, especially in the case of those patients who have moved from the Healthy Families program to Medi-Cal managed care. In Phase 1, patients are going to be already enrolled in the same plan they had before unless they have asked to change to another participating Medi-Cal managed care plan, thus another reason for verifying enrollment information
CMA will provide additional information as it becomes available. Additional details on the Healthy Families program to Medi-Cal transition, including answers to frequently asked questions, are available online at www.dhcs.ca.gov/services/Pages/HealthyFamiliesTransition.aspx.
CMA and DHCS are also cohosting a webinar on the Healthy Families Program transition on February 5, 2013, at 12:15 p.m. The webinar, “Healthy Families: Important Program Changes Practices Need to Know,” is free to all interested parties.
DHCS will present an overview of the transition. The webinar will also include the current status of the transition, a summary of the implementation phases in 2013 and information about DHCS’ monitoring and oversight of health plans participating in this transition.
Contact: CMA’s reimbursement helpline, (888) 401-5911 or firstname.lastname@example.org.