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Healthy Families Program Transition to Medi-Cal October 23, 2012
AGENDA Vaccines for Children Program Updates • Notices • Federal Approval • Stakeholder Engagement Review Strategic Framework
Vaccines for Children Program Statewide • Program Overview • Program Enrollment • Existing Providers • New Providers • Ordering • Contact Information: www.eziz.org
Notices • Timing • Stakeholder Engagement • Medi-Cal Threshold Languages • Appropriate Reading Level
Update: Federal Approval
Federal Approvals • DHCS • Medi-Cal 1115 Waiver Amendment • Title XIX (Medi-Cal) State Plan Amendment • MRMIB • Title XXI (HFP) State Plan Amendment
Update: Stakeholder Engagement
Review Strategic Framework
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.
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)
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)
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
State Monitoring • DMHC Plan Surveys • DHCS Plan Surveys and Audits • Performance Measures and Metrics
Next Stakeholder Webinar Date: Friday, December 7, 2012 Time: 1:00pm to 3:00pm Location: DHCS Auditorium, 1500 Capitol Ave, Sacramento
Contact Us DHCS Information/Questions DHCSHealthyFamiliesTransition@dhcs.ca.gov http://www.dhcs.ca.gov/services/Pages/HealthyFamiliesTransition.aspx MRMIB Information/Questions firstname.lastname@example.org http://mrmib.ca.gov/MRMIB/HFPTransition.html