healthy families program transition to medi cal october 23 2012 n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Healthy Families Program Transition to Medi-Cal October 23, 2012 PowerPoint Presentation
Download Presentation
Healthy Families Program Transition to Medi-Cal October 23, 2012

Loading in 2 Seconds...

play fullscreen
1 / 18
rashad

Healthy Families Program Transition to Medi-Cal October 23, 2012 - PowerPoint PPT Presentation

142 Views
Download Presentation
Healthy Families Program Transition to Medi-Cal October 23, 2012
An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

  1. Healthy Families Program Transition to Medi-Cal October 23, 2012

  2. AGENDA Vaccines for Children Program Updates • Notices • Federal Approval • Stakeholder Engagement Review Strategic Framework

  3. Vaccines for Children Program

  4. Vaccines for Children Program Statewide • Program Overview • Program Enrollment • Existing Providers • New Providers • Ordering • Contact Information: www.eziz.org

  5. Update: Notices

  6. Notices • Timing • Stakeholder Engagement • Medi-Cal Threshold Languages • Appropriate Reading Level

  7. Update: Federal Approval

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

  9. Update: Stakeholder Engagement

  10. Review Strategic Framework

  11. Program Overview and Legislative Requirements • 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.

  12. Methods and Processes for Stakeholder Engagement • California Health and Human Services Agency (CHHS) • Managed Risk Medical Insurance Board (MRMIB) • Department of Health Care Services (DHCS) • Medi-Cal Managed Care Division • Dental Services Division • Medi-Cal Eligibility Division • Department of Managed Health Care (DMHC)

  13. State, County, and Local Administrative Components • Eligibility Processing and Enrollment (MCED) • Enrollment Communication and Outreach • County Coordination • Payments of Applicable Premiums and Overall Systems Operation (MCED) • Linkage with Health Plan Providers (MDSD & MMCD)

  14. Health Care and Dental Delivery System Components • Network Adequacy • Medical and Dental Managed Care • Fee-for-Service Denti-Cal • Network Adequacy Assessments • Financial Solvency • Related Factors That Ensure Timely Access to Care

  15. State Monitoring • DMHC Plan Surveys • DHCS Plan Surveys and Audits • Performance Measures and Metrics

  16. Questions and Answers

  17. Next Stakeholder Webinar Date: Friday, December 7, 2012 Time: 1:00pm to 3:00pm Location: DHCS Auditorium, 1500 Capitol Ave, Sacramento

  18. Contact Us DHCS Information/Questions DHCSHealthyFamiliesTransition@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