November 05, 2013
Area(s) of Interest: Access to Care Payor Issues and Reimbursement Public Payors
The Department of Health Care Services (DHCS) implemented phase 2 of the expansion of Medi-Cal managed care into the remaining 10 rural fee-for-service counties on November 1, 2013.
On this date, approximately 27,000 Medi-Cal fee-for-service enrollees in Alpine, Amador, Butte, Calaveras, Colusa, El Dorado, Glenn, Imperial, Inyo, Mariposa, Mono, Nevada, Placer, Plumas, San Benito Sierra, Sutter, Tehama, Tuolumne and Yuba counties were transitioned to Medi-Cal managed care plans. Another 84,000 are eligible to voluntarily choose a managed care plan.
This follows the transition of 8,000 Medi-Cal fee-for-service enrollees in Del Norte, Humboldt, Lake, Lassen, Modoc, Shasta, Siskiyou and Trinity counties that occurred on September 1.
In July, DHCS announced that for purposes of consistency and to ensure the readiness of the plans, the rural expansion transition will be split into two phases to coincide with Healthy Families transition phases 4a and 4b.
Practices are encouraged to re-verify eligibility of their Medi-Cal patients on or after the above effective dates to ensure eligibility, that the correct payor is billed and to prevent denials of claims.
For more information on the rural managed care expansion, visit the DHCS Medi-Cal Managed Care Rural Expansion page at www.dhcs.ca.gov. Questions or comments for DHCS can be sent via email to DHCSHealthyFamiliesTransition@dhcs.ca.gov.