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Medi-Cal Redesign

Medi-Cal Redesign

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Medi-Cal Redesign

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Presentation Transcript

  1. Medi-Cal Redesign Stakeholders Meeting

  2. AGENDA • Welcome and Opening Comments • Kim Belshé, Health and Human Services Secretary • Proposal Overview, Timeframes, and Stakeholders Sessions • Stan Rosenstein, Deputy Director, Medical Care Services, Department of Health Services • Questions and Answers • Tom McCaffery, Chief Deputy Director, Department of Health Services

  3. Welcome and Opening Comments Secretary Kim Belshé

  4. Overview, Timeframe, and Stakeholders Sessions Stan Rosenstein

  5. Medi-Cal Redesign Goals • Protect eligibility for those people currently eligible • Maintain essential services and align coverage with private sector • Continue services to children as aMedi-Cal priority • Increase the personal responsibility of Medi-Cal beneficiaries by requiring they share in the cost of services

  6. Medi-Cal Redesign Goals Continued… • Promote work participation by continuing coverage of the working poor and allowing people to continue to maintain Medi-Cal coverage while their work income increases • Improve program effectiveness and accountability by promoting organized delivery systems

  7. Medicaid Demonstration Waiver • Provide California with the flexibility to redesign Medi-Cal, allowing it to continue to maintain coverage of people current eligible, provide essential care, and be affordable to the State • Other states have done waivers to gain more flexibility in the operation of their Medicaid programs, examples include Oregon and Utah • California’s first comprehensive waiver

  8. Potential Components of Redesign • Various options for redesign are being considered • Final proposal will be developed after discussions with Stakeholders and Legislature

  9. Concept: Align Medi-Cal’s eligibility standards and processes for families and children with those of CalWORKs Use Medi-Cal rules for the Aged, Blind, and Disabled Simplify the determination of financial responsibility of parent-for-child and spouse-for-spouse will be simplified Simplify Medi-Cal Eligibility

  10. Simplify Medi-Cal Eligibility Continued… Rationale • Medi-Cal is an excessively complex array of eligibility standards and programs and, consequently, costly and confusing to administer • Redesign will simplify the program for beneficiaries and counties

  11. Concepts: Multi-tiered Benefit Structure Full scope Medi-Cal benefits for newly defined mandatory eligibles Full scope benefits for all eligible children A basic benefit package for optional eligibles with greater beneficiary cost sharing A more comprehensive benefit package for optional eligibles that want to pay a larger monthly premium Modify Benefit Structure

  12. Make services more consistent with private insurance and other Medicaid programs Establish premiums for optional beneficiaries Create a meaningful co-pay program with optional beneficiaries having greater cost sharing. Gain control over program expenditures by redefining the medical necessity standard for benefits for children Modify Benefit Structure Continued…

  13. Modify Benefit Structure Continued… Rationale • Benefit restructuring will enable the State to continue to maintain coverage of people currently eligible, provide essential care, and better control program costs. It will promote a more cost effective utilization and delivery of Medi-Cal Services by beneficiaries and providers

  14. Concept: Expand mandatory enrollment for parents and children to additional counties Broaden utilization of organized delivery systems for the aged, blind, and disabled (ABD) population Rationale: Better access to providers, coordination of care, improved quality of care, and reduced preventable hospitalizations. Modify Delivery Systems

  15. Timetables

  16. TimetableMedi-Cal Redesign • January 2004 Start stakeholders meetings and continue throughout the process • May 2004 Waiver concept paper submitted to the Legislature • July 2004 Obtain budget trailer bill language to implement • October 2004 Submit waiver to CMS

  17. TimetableMedi-Cal Redesign Continued • December 2004 CMS approval of waiver • December 2004-June 2005 County and system changes • July 2005 through June 2006 Phased in waiver implementation

  18. Future Stakeholders Meetings • Next introductory meeting in Los Angeles (TBA) • Divide into work groups • Eligibility • Benefits and Beneficiary Cost Sharing • Managed Care • Monthly meetings during waiver development • Please volunteer for a work group • Public hearings on waiver before final submission

  19. Additional Questions & Comments If you have additional questions and/or comments, please e-mail them to