Healthy Families Program Transition to Medi-Cal September 13, 2012

1. Healthy Families Program Transition to Medi-Cal September 13, 2012

2. Update: Network Adequacy

3. Network Adequacy • Requests for health and dental plan provider network data: Sent to plans August/early September • Health and dental plan responses: Due September 14 • DMHC and DHCS joint review and evaluation of data • Network adequacy assessment: Provide to Legislature 60 days prior to the start of Phase 1

4. Update: HFP Subscriber General Notice

5. Notices • HFP Notices: General Notice, 90-Day, 60-Day, 30-Day. • Medi-Cal “Welcome” notice post-transition. • Stakeholder engagement for notices. • Will translate in the Medi-Cal threshold languages. • Center for Health Literacy will review for Reading Level.

6. Review Draft Strategic Plan Due: October 1, 2012

7. Program Overview and Legislative Requirements • Transfer HFP subscribers to Medi-Cal no sooner than January 1, 2013, over 4 phases • Strategic Plan due October 1, 2012 • Certify Phase 1 network adequacy November 1, 2012 • Submit Implementation Plans 60 days prior to start of each phase • Monthly ongoing reporting commencing February 15, 2013

8. Program Overview and Legislative Requirements Goals of Transition • Facilitate a smooth transition • Minimize disruption in services • Maintain eligibility gateways • Ensure access to care • Ensure continuity of care

9. Program Overview and Legislative RequirementsSummary of Phases • Phase 1 (No sooner than January 1, 2013) • Individuals enrolled in a Healthy Families Program health plan that is a Medi-Cal managed care health plan shall be enrolled in the same plan. Approximately 411,654 children will transition. • Phase 2 (No sooner than April 1, 2013) • Individuals enrolled in a Healthy Families Program health plan that is a subcontractor of a Medi-Cal managed health care plan, to the extent possible, shall be enrolled into a Medi-Cal managed care health care plan that includes the individuals’ current plan. Approximately 261,060 children will transition. • Phase 3 (No sooner than August 1, 2013) • Individuals enrolled in a Healthy Families Program plan that is not a Medi-Cal managed care plan and does not contract or subcontract with a Medi-Cal managed care plan shall be enrolled in a Medi-Cal managed care plan in that county. Enrollment shall include consideration of the individuals’ primary care providers. Approximately 152,602 children will transition. • Phase 4 (No sooner than September 1, 2013) • Individuals residing in a county that is not a Medi-Cal managed care county shall be provided services under the Medi-Cal fee-for-service delivery system. Approximately 42,753 children will transition.

10. Key Activities for Phase 1 Planning • Review and Analysis of Provider Network Review Data from Plans (health and dental) • All County Welfare Director Letter Reviews with Stakeholders and Counties; Release of 2nd drafts • DHCS IT, MCED, Counties, Consortia and MAXIMUS determine data transfer protocols • Welcome Package review with stakeholders • State Plan/Waiver Amendment development and submission • Provide Strategic Plan to Legislature by October 1, 2012 • Deliver Certification of Network Adequacy to the Legislature by November 1, 2012

11. Communication • Committed to collaboration and coordination of transition • Ensure transparency and public/stakeholder engagement in the process • DHCS Managed Care, Eligibility, and Dental Division Stakeholder Meetings • MRMIB Monthly Board Meetings, CAA Network, HFP Advisory Panel • DMHC Quarterly Plan and Advocate Meetings • Combined Webinars, Children’s Groups, and Small Stakeholder Groups

12. Eligibility and Enrollment • Outreach to Subscribers/Families • General Notice, and 90, 60, 30 Day Notices for Each Phase • What We Tell Families Grid • County Coordination • Eligibility Determinations • Eligibility Data Reports and Performance Standards • MAXIMUS Coordination • Cost-Sharing: Premium Management and Co-Payments

13. Health and Dental Plan Transition • Health Plans • Network Adequacy • Continuity of Care • Dental Plans and Fee-for-Service • Network Adequacy • Continuity of Care • Fee-for-Service Provider Enrollment

14. Health and Dental Plan Transition Performance Measures • Health Plans • Child-Only HEDIS Measures • Ongoing Network Adequacy • Beneficiary Satisfaction Surveys • Dental Plans and Fee-for-Service

15. Health and Dental Plan Transition DMHC Oversight • Pre- and Post-Transition Network Adequacy Assessments • Ongoing Fiscal Solvency Examinations, Medical Surveys, and Transition-Related Health Plan Filings • DMHC Help Center

16. Federal Approvals • DHCS • Title XIX (Medi-Cal) State Plan Amendment • Medi-Cal 1115 Bridge to Reform Waiver • MRMIB • Title XXI (HFP) State Plan Amendment

17. Considerations for Input • Is any additional content needed? • Have all key areas been addressed? • Are there any major omissions of information? • What are suggested changes to the layout of the plan? • What data elements should be included?

18. Next Steps • 5:00 PM, Thursday, September 20, 2012 • Deadline to Submit Comments on Draft Strategic Plan • Upcoming Stakeholder Webinars • 2 – 4pm, Tuesday, October 23, 2012 • 1 – 3pm, Friday, December 7, 2012

19. Questions and Answers

20. Contact Us DHCS Information/Questions DHCS Healthy Families Transition@dhcs.ca.gov http://www.dhcs.ca.gov/services/Pages/HealthyFamiliesTransition.aspx MRMIB Information/Questions hfptransition@mrmib.ca.gov http://mrmib.ca.gov/MRMIB/HFPTransition.html