Medi -Cal Expansion & HWLA Transition Staff Webinar Alison Klurfeld November 8, 2013

1. Medi-Cal Expansion & HWLA Transition Staff WebinarAlison KlurfeldNovember 8, 2013

2. Today’s Presentation • Introduction to Medi-Cal Expansion • Expanded Eligibility & HWLA Transition • Enrollment & Eligibility Simplification • New Behavioral Health Benefits • Expansion and Transition Goals

3. Introduction to Medi-Cal Expansion

4. ACA Expands Health Insurance Coverage The Affordable Care Act of 2010 (ACA): • Covered California • Health benefits exchange for moderate to high income individuals & small businesses • Medi-Cal Expansion • Health coverage for low-income individuals

5. Introduction: Medi-Cal Expansion What will change in Medi-Cal on 1/1/2014? • Expanded eligibility • Enrollment and eligibility simplification • New behavioral health benefits

6. Expanded Eligibility & HWLA Transition

7. Medi-Cal Eligibility: Today • Children (250% FPL) • Parents w/dependent children (100% FPL) • Pregnant women (200% FPL) • Low income seniors (133% FPL) • People with disabilities (133% FPL)

8. Medi-Cal Eligibility: Tomorrow • All citizens and legal permanent residents (LPRs) of 5+years with incomes up to 138% FPL* • LPRs of under 5 years up to 100% FPL • Biggest change = childless adults *133% and 138% of FPL are used interchangeably because the Affordable Care Act simplifies the way that you calculate income for Medi-Cal. It creates a blanket disregard of 5% of FPL, so 133% is effectively equal to 138%.

9. Where are these new enrollees now? • Healthy Way LA (HWLA) • LA County’s Low Income Health Program (LIHP) • Early Medi-Cal expansion • Uninsured • Eligible for HWLA but not enrolled

10. Healthy Way L.A. Program • Current ~ 275,000 members • Goal = 300,000 by December 2013 • Uninsured adults 19-64 <133% Federal Poverty Level with legal residency status • Benefits are “Medi-Cal - like” (physician, hospital, ancillary, pharmacy, mental health, nurse advice line) • Enrollment through DHS, Community Partner clinics, and on-line

11. HWLA Provider Network

12. How will HWLA members transition to Medi-Cal? • Auto-enrollment of individuals enrolled in HWLA into Medi-Cal Program as of January 1, 2014. • Continuity of care with existing provider (PCP & specialist); • Right to change to a different provider; • Beneficiary choice of plan and provider; • Default to existing provider if no selection.

13. HWLA Transition Timeline 1/1/2014 Medi-Cal MCP Welcome Packet 10/15/13 1st Wave HWLA Member MEDS Extract 11/15/13 2nd Wave HWLA Member MEDS Extract ~ 3/1/2014 Late HWLA enrollees (after 11/15/13) move to managed care 12/30/13 State HWLA conversion to Medi-Cal • 9/13FAQ / script for HWLA staff LA Care expects ~ 160,000 new Medi-Cal members on 1/1/2014. 11/1/13 1st Wave HCO Plan Choice Package Start of 60 day clock 10/2/13 First joint state-county notice sent 12/1/13 HCO Medi-Cal Plan Choice / Assignment Reminder Notice 12/31/13 HWLA program ends

14. Uninsured Expansion Population • Same demographics as HWLA: uninsured adults 19-64 <133% FPL with legal residency status • May not sign up until 2014 (although eligible for HWLA): • Disconnected from care • Receiving episodic care only • Failed to redetermine for HWLA • Different autoassignment algorithm: • 75% of members who don’t pick a PCP assigned to DHS.

15. Medi-Cal Member Assignment in 2014 HCO Plan Choice Form No Choice/ Passive Enrollment Choice of Plan and Provider LA Care provider assignment differs by type of beneficiary: Newly eligible childless adult, former HWLA (L1 aid code) Newly eligible childless adult, not former HWLA (aid code M3) Existing coverage group (child, parent, pregnant, SPD) 75% to DHS Assigned to HWLA medical home contracted w/L.A. Care (prior affiliation) HWLA medical home NOT contracted w/LA Care: Current Assignment Algorithms Current Assignment Algorithms

16. Expanded Eligibility: Benefits Newly eligibles (childless adults): • Same benefits as existing Medi-Cal beneficiaries.

17. Enrollment & Eligibility Simplification

18. Modified Adjusted Gross Income Modified Adjusted Gross Income (MAGI) – for some beneficiaries • New eligibility determination process • Simpler way of counting income to determine Medi-Cal eligibility. • Same method the IRS uses for taxes. • No asset test at time of enrollment • New aid codes (TBD)

19. Eligibility & Redeterminations • 12 months of continuous eligibility for MAGI beneficiaries, even if income changes mid-year. • Eliminates mid-year status review. • Redeterminations: • Suspended between 1/1/2014 and 3/31/2014 for all Medi-Cal beneficiaries. • MAGI-eligible beneficiaries receive new aid code at redetermination.

20. New Behavioral Health Benefits

21. New behavioral health benefits • New benefits for all Medi-Cal beneficiaries: • Mental health and substance use disorder services included in the state essential health benefits package. • Still mostly provided and paid for by county DMH & DPH, but some new health plan services. • DHCS contract amendment language expected late October / early November.

22. Medi-Cal MH/SUD Delivery System County Mental Health Plan (MHP) County Alcohol and Other Drug Programs (AOD) Medi-Cal Managed Care Plans (MCP) Target Population: Children and adults who meet medical necessity or EPSDT criteria for Drug Medi-Cal Substance Use Disorder Services Target Population: Children and adults in Managed Care Plans who meet medical necessity or EPSDT for Mental Health Services Target Population: Children and adults who meet medical necessity or EPSDT criteria for Medi-Cal Specialty Mental health Services • Outpatient Services • Outpatient Drug Free • Intensive Outpatient (newly expanded to additional populations) • Residential Services (newly expanded to additional populations) • Narcotic Treatment Program • Naltrexone • New Services • Voluntary Inpatient Detoxification Services • MCP services to be carved-in effective 1/1/14* • Individual/group mental health evaluation and treatment (psychotherapy) • Psychological testing when clinically indicated to evaluate a mental health condition • Psychiatric consultation for medication management • Outpatient laboratory, supplies and supplements • Screening and Brief Intervention (SBI) (new service not currently offered) • Drugs, excluding anti-psychotic drugs (which are covered by Medi-Cal FFS) • Outpatient Services • Mental Health Services (assessments plan development, therapy, rehabilitation and collateral) • Medication Support • Day Treatment Services and Day Rehabilitation • Crises Intervention and Crises Stabilization • Targeted Case Management • Therapeutic Behavior Services • Residential Services • Adult Residential Treatment Services • Crises Residential Treatment Services • Inpatient Services • Acute Psychiatric Inpatient Hospital Services • Psychiatric Inpatient Hospital Professional Services • Psychiatric Health Facility services * MCP carve-in services, except for SBI, are currently offered through Medi-Cal FFS As of October 11, 2013

23. Expansion & Transition Goals

24. Expansion and Transition Goals • Seamless for beneficiaries. • Maintain continuity of care • Accurately link to existing medical homes • Education and support for beneficiaries, providers, and LA Care staff • Collaboration with safety net partners • Alignment with Exchange and Cal Medi-Connect • Planned and on-schedule

25. Resources • Executive Sponsor: John Wallace • Project Leads: Maribel Ferrer & Maria Calleros • Medi-Cal Expansion Intranet page: • http://insidelac/medi-cal-expansion • Questions? Email Alison Klurfeld: • aklurfeld@lacare.org

26. Questions?