November 03, 2014
Area(s) of Interest: Payor Issues and Reimbursement Public Payors
Between June 2011 and May 2012, California moved approximately 380,000 seniors and persons with disabilities (SPDs) in 21 counties from Medi-Cal fee-for-service to managed care. The change was intended to improve care coordination and access to care in the long term. The SPD transition is unrelated to the current eight-county dual eligible pilot project for Cal MediConnect.
The 2014-15 state budget included language that changed managed care enrollment for the Medi-Cal only SPD population from voluntary to mandatory effective December 1, 2014. Previously this transition was scheduled for September 1, 2014.
There are approximately 25,000 SPDs expected to transition in the following counties: Alpine, Amador, Butte, Calaveras, Colusa, El Dorado, Glenn, Imperial, Inyo, Mariposa, Mono, Nevada, Placer, Plumas, San Benito, Sierra, Sutter, Tehama, Tuolumne and Yuba.
In San Benito, managed care enrollment for SPDs will remain voluntary since there is only one participating health plan in that county.