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JUNE 2014 • VER SION 3 Advocate’s Guide to California’s Coordinated Care Initiative ADVOCATE’S GUIDE TO CALIFORNIA’S COORDINATED CARE INITIATIVE • 1 By Amber Cutler, Anna Rich and Silvia Yee About This Guide This Guide is designed for advocates and individuals who provide assistance to dual eligibles and seniors and persons with disabilites (SPDs). The Natonal Senior Citzens Law Center (NSCLC) and Disability Rights Educaton and Defense Fund (DREDF) strive to make the informaton in this Guide as accurate as possible as of the publicaton date (June 27, 2014). However, many of the details about the CCI are stll in fux. To get the most up-to-date informaton on the CCI and sign-up for alerts, NSCLC webinars, and other trainings, please visit our website www.dualsdemoadvocacy.org/california or email Jenni Choi at [email protected]. You can also subscribe to the DHCS’s ofcial listserv to receive program updates at www.calduals.org. This is Version Three of the Guide. The CCI has undergone signifcant changes from the last publicaton of this Guide. Prior versions are outdated and should be discarded. NSCLC advocates for the rights of low-income seniors and persons with disabilites to access healthcare. NSCLC cannot represent individuals in their claims for benefts, but we can provide technical assistance and advice to advocates. DREDF also does not provide individual representaton on beneft eligibility or amounts. DREDF staf gives informaton and referrals for individual benefts assistance, and technical assistance on disability civil rights to legal service advocates. DREDF is also tracking failures to comply with federal and state disability rights laws and provide reasonable accommodatons to beneft applicants and enrollees. For more informaton about other organizatons that assist consumers, see Appendix A.

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  • j u n e 2 0 1 4 v e r s i o n 3

    Advocates Guide to Californias Coordinated Care initiative

    A d v o c At es G u i d e to c A l i f o r n i As co o r d i n At e d c A r e i n i t i At i v e 1

    By Amber Cutler, Anna rich and silvia Yee

    About this Guide

    This Guide is designed for advocates and individuals who provide assistance to dual eligibles and seniors and persons with disabilities (SPDs). The National Senior Citizens Law Center (NSCLC) and Disability Rights Education and Defense Fund (DREDF) strive to make the information in this Guide as accurate as possible as of the publication date (June 27, 2014). However, many of the details about the CCI are still in flux. To get the most up-to-date information on the CCI and sign-up for alerts, NSCLC webinars, and other trainings, please visit our website www.dualsdemoadvocacy.org/california or email Jenni Choi at [email protected]. You can also subscribe to the DHCSs official listserv to receive program updates at www.calduals.org. This is Version Three of the Guide. The CCI has undergone significant changes from the last publication of this Guide. Prior versions are outdated and should be discarded.

    NSCLC advocates for the rights of low-income seniors and persons with disabilities to access healthcare. NSCLC cannot represent individuals in their claims for benefits, but we can provide technical assistance and advice to advocates. DREDF also does not provide individual representation on benefit eligibility or amounts. DREDF staff gives information and referrals for individual benefits assistance, and technical assistance on disability civil rights to legal service advocates. DREDF is also tracking failures to comply with federal and state disability rights laws and provide reasonable accommodations to benefit applicants and enrollees. For more information about other organizations that assist consumers, see Appendix A.

    http://www.dualsdemoadvocacy.org/californiamailto:jchoi%40nsclc.org?subject=www.calduals.org

  • A d v o c At es G u i d e to c A l i f o r n i As co o r d i n At e d c A r e i n i t i At i v e 2

    A D V O C A T E S g u i D E

    A d v o c At es G u i d e to c A l i f o r n i As co o r d i n At e d c A r e i n i t i At i v e 3

    executive summary

    Implementation of the Coordinated Care Initiative (CCI) is now underway in Los Angeles,

    Riverside, San Diego, San Bernardino, and San Mateo counties. There have been significant

    changes to the CCI since the release of the second version of the Advocates Guide to

    Californias Coordinated Care Initiative in September 2013. Version Three of the Guide includes

    these important changes and provides the most recent information on the CCI. If you have

    saved or printed Version Two, please replace it with Version Three because the former contains

    outdated information.

    The National Senior Citizens Law Center provides bi-weekly updates to advocates on the CCI.

    To sign up for these updates, contact [email protected]. NSCLC also maintains a CCI fix-list

    documenting the problems brought to the attention of NSCLC during the implementation of the

    CCI. The CCI Fix List is available at http://dualsdemoadvocacy.org/california/cci-fix-list.

    Acknowledgments

    The development of this Guide would not have been possible without the support of The SCAN Foundation and the California Wellness Foundation. The authors wish to thank our colleagues at Disability Rights California, National Health Law Program, Disability Rights Education and Defense Fund, and the National Senior Citizens Law Center, for their contributions and willingness to help in a variety of ways, in particular Nancy Arvalo, Mary Lou Breslin, Dan Brzovic, Georgia Burke, Denny Chan, Jenni Choi, Kimberly Lewis, Scott Parkin, Kevin Prindiville and Elizabeth Zirker. The authors also wish to thank the California Department of Health Care Services and The SCAN Foundation for their review and comments.

    Supported by a grant from The SCAN Foundation - advancing a coordinated and easily navigated system of high-quality services for older adults that preserve dignity and independence. For more information, visit www.TheSCANFoundation.org.

    This Guide is also supported in part by a grant from The California Wellness Foundation (TCWF). Created in 1992 as a private independent foundation, TCWF's mission is to improve the health of the people of California by making grants for health promotion, wellness education and disease prevention.

    www.TheSCANFoundation.orgmailto:info%40calduals.org?subject=http://dualsdemoadvocacy.org/california/cci-fix-list

  • A d v o c At es G u i d e to c A l i f o r n i As co o r d i n At e d c A r e i n i t i At i v e 3

    A D V O C A T E S g u i D E

    Table of ConTenTs About This Guide ..................................................................................................................................1Executive Summary................................................................................................................................. 2Acknowledgments.................................................................................................................................... 2Glossary.................................................................................................................................................... 5Introduction.............................................................................................................................................. 7What is the Coordinated Care Initiative (CCI)?......................................................................................... 7

    Mandatory Enrollment in Medi-Cal Managed Care........................................................................... 7 LTSS Integration ................................................................................................................................ 8 Cal MediConnect................................................................................................................................8

    Frequently Asked Questions...................................................................................................10Who Does the CCI Impact and How? ...................................................................................................12Medi-Cal Managed Care..................................................................................................................12Cal MediConnect..............................................................................................................................13

    Frequently Asked Questions...................................................................................................15CCI Eligibility Chart..................................................................................................................20

    Covered Benefits....................................................................................................................................24Medi-Cal Managed Care Benefits...................................................................................................24Cal MediConnect Benefits................................................................................................................24

    Frequently Asked Questions...................................................................................................26Purposes of the CCI ..............................................................................................................................27

    Frequently Asked Questions.................................................................................................28CCI Timeline and Enrollment.............................................................................................................. 29Cal MediConnect Enrollment.......................................................................................................... 29Medi-Cal managed care and LTSS-only enrollment.....................................................................30

    Frequently Asked Questions....................................................................................................30Notices.... ...................... ....... ............... ....... ...................... ...................... ...................... ....... 31Medi-Cal Managed Care Notices................................................................................................... 31Cal MediConnect Notices.................................................................................................................32

    Frequently Asked Questions...................................................................................................32CalMediConnect Plans.......................................................................................................................... 33

    Marketing Rules............................ ...........................................................................................................34

  • A d v o c At es G u i d e to c A l i f o r n i As co o r d i n At e d c A r e i n i t i At i v e 4

    A D V O C A T E S g u i D E

    A d v o c At es G u i d e to c A l i f o r n i As co o r d i n At e d c A r e i n i t i At i v e 5

    Factors a Beneficiary Should Consider in Deciding to Enroll or Opt Out of Cal MediConnect...........................................................................................................................................34

    Frequently Asked Questions...................................................................................


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