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