100,000 Covered California enrollees being transitioned into Medi-Cal managed care in January

January 09, 2015

The California Department of Health Care Services (DHCS) recently announced that approximately 100,000 Covered California enrollees were transitioned from exchange plans into Medi-Cal managed care plans effective January 1, 2015. According to the DHCS bulletin, the affected individuals no longer qualify for Covered California products due to changes in their income and/or family size.

Enrollees whose Covered California plan also offers a Medi-Cal managed care plan in their area will transition to the matching Medi-Cal Managed care plan with no lapse in coverage. Those who had a Covered California plan that did not offer a Medi-Cal managed care plan in their area were automatically enrolled in a managed care plan in their county. Typically, when patients are transitioned to a different plan, there is an effort to maintain continuity of care by matching patients to plans that include their primary care physician. However, CMA has learned that this information was not available at the time of the transition, thus many of these patients were randomly assigned to a managed care plan.

Patients who wish to switch Medi-Cal managed care plans can do so at any time by calling Health Care Options at (800)-430-4263. Coverage will be effective in the following month.

In an All Plan Letter dated December 29, 2014, DHCS outlined continuity of care requirements of Medi-Cal managed care plans (page 5) for patients who are required to switch plans. Specifically, plans are required to contact affected patients within 15 days of enrollment to help the patient initiate the continuity of care process. Additionally, Medi-Cal managed care plans are required to honor prior authorizations for up to 60 days or until a new assessment is completed by the plan. For more information on continuity of care, see CMA On Call document #7051, “Contract Termination by Physicians and Continuity of Care Provisions,” available free to members in CMA's online resource library.

Notices of the change were sent to patients by Covered California at the end of December and new ID cards were mailed the first week of January.

This change reinforces the importance of verifying eligibility each time the patient is seen to confirm their coverage, whether the physician is in-network with the plan and that the correct payor is billed. Physicians can access the Medi-Cal automated eligibility verification system using the patient's social security number if a patient does not yet have an ID card at the time of service.


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