1115 Waiver Proposals

1. 1115 Waiver Proposals California Children’s Services Program

2. Medi-Cal Managed Care Plan • Fully-capitated, at risk • Knox-Keene licensed plan providing services to entire population • All children with all CCS eligible medical conditions • Disenrollment from Healthy Families plan • Mandatory enrollment

3. Medi-Cal Managed Care Plan • Managing and/or coordinating all of the child’s health care needs • Benefits • Medically necessary services to treatment the ‘whole child’ • Same range of currently covered services • Primary and preventive care • Medically necessary services to treat the CCS condition • Care coordination • Outreach and Assessment

4. Medi-Cal Managed Care Plan • Provider network • CCS approved providers • Hospitals • Individual providers • Special care centers

5. Medi-Cal Managed Care Plan • Medical home and care coordination • Personal physician • Active family participation in decision-making • Information technology • Care coordinators to support physicans

6. Medi-Cal Managed Care Plan • Medical home and care coordination • Participation in quality improvement activities • Providers • Patients and families

7. Medi-Cal Managed Care Plan • Administration • 24/7 nurse advise line • Member services • Member education • Quality monitoring and improvement

8. Specialty Health Care Plan • Fully capitated, at risk • Knox-Keene licensed plan only providing services to children with CCS eligible medical conditions • Managing and/or coordinating all of the child’s health care needs • Mandatory enrollment • Disenrollment from • Medi-Cal managed care plan • Healthy Families plan

9. Specialty Health Plan • Provider network • CCS approved providers • Hospitals • Individual providers • Special care centers

10. Specialty Health Care Plan • Benefits • Medically necessary services to treat the ‘whole child’ • Same range of currently covered services • Primary and preventive care • Medically necessary services to treat the CCS condition • Care coordination

11. Specialty Health Care Plan • Medical home and care coordination • Personal physician • Active family participation in decision-making • Information technology • Care coordinators to support physicans

12. Specialty Health Care Plan • Medical home and care coordination • Participation in quality improvement activities • Providers • Patients and families • 24/7 access to care • Reimbursement • Quality monitoring and improvement

13. Specialty Health Care Plan • Administration • 24/7 nurse advise line • Member services • Member education • Member outreach and assessment