Have you received your supplemental Medi-Cal managed care payments?

September 20, 2018
Area(s) of Interest: Advocacy Practice Management Payor Issues and Reimbursement 

The California Health Care, Research and Prevention Tobacco Tax Act of 2016 (Prop 56) created new revenues dedicated to the Medi-Cal program. Physicians receive supplemental payments in both fee-for-service and Medi-Cal managed care when providing Medi-Cal services under certain CPT codes. 

While the California Department of Health Care Services (DHCS) began disbursing FY 2017-2018 supplemental fee-for-service payments in January 2018, federal approval of the supplemental Medi-Cal managed care payments was delayed. This resulted in delayed payment for Medi-Cal managed care services.

DHCS began dispersing the FY 2017-2018 funds to the plans as part of its capitated payments in May.  This includes both the go-forward payments and the retroactive payment for clean claims or accepted encounter data with dates of service between July 1, 2017, and the date the plan received the Prop 56 funds.

Plans were required to issue supplemental payments to qualifying physicians within 90 days. The 90-day window ended August 31 and physicians should have already received their supplemental payments.

Practices that believe they have not received their supplemental payments, should contact the plan. Plans chose to pay physicians directly, pass all payment responsibility down to their delegated plan/groups or split the payment responsibility between the plan and the delegated plan/group.

CMA has created a comprehensive list (below) of Medi-Cal Managed Care plans identifying who distributed the incentive.

Physicians with questions can contact CMA’s Reimbursement Helpline at (888) 401-5911.

Medi-Cal Managed Care Plan Entity Paying (plan vs. delegated group)
Aetna Plan
Anthem Blue Cross Plan
Cal Optima Both
California Health & Wellness Plan
CalViva Health Both
Care 1st (purchased by Blue Shield) Both
CenCal Plan
Central California Alliance for Health Plan (except behavioral health, which will be paid through delegated group)
Community Health Group Both
Contra Costa Health Plan Plan
Gold Coast Health Plan Plan
Health Net Both
Health Plan of San Joaquin Plan
Health Plan of San Mateo Plan
Inland Empire Health Plan Plan
Kern Family Health Plan
LA Care Delegated groups
Molina Both
Partnership Health Plan Plan
San Francisco Health Plan Both
Santa Clara Family Health Both
UnitedHealthCare Plan


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