healthy families program transition to medi-cal october 23, 2012

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

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

Healthy Families Program Transition to Medi-Cal

October 23, 2012

Page 2: 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

Page 3: Healthy Families Program Transition to Medi-Cal October 23, 2012

Vaccines for Children Program

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Page 4: Healthy Families Program Transition to Medi-Cal October 23, 2012

Vaccines for Children Program Statewide

• Program Overview

• Program Enrollment

• Existing Providers

• New Providers

• Ordering

• Contact Information: www.eziz.org

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Page 5: Healthy Families Program Transition to Medi-Cal October 23, 2012

Update:

Notices

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Page 6: Healthy Families Program Transition to Medi-Cal October 23, 2012

Notices

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• Timing

• Stakeholder Engagement

• Medi-Cal Threshold Languages• Appropriate Reading Level

Page 7: Healthy Families Program Transition to Medi-Cal October 23, 2012

Update:

Federal Approval

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Page 8: Healthy Families Program Transition to Medi-Cal October 23, 2012

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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Page 9: Healthy Families Program Transition to Medi-Cal October 23, 2012

Update:

Stakeholder Engagement

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Page 10: Healthy Families Program Transition to Medi-Cal October 23, 2012

Review

Strategic Framework

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Page 11: Healthy Families Program Transition to Medi-Cal October 23, 2012

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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

Page 12: Healthy Families Program Transition to Medi-Cal October 23, 2012

• 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

Page 13: Healthy Families Program Transition to Medi-Cal October 23, 2012

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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Page 14: Healthy Families Program Transition to Medi-Cal October 23, 2012

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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Page 15: Healthy Families Program Transition to Medi-Cal October 23, 2012

State Monitoring

• DMHC Plan Surveys

• DHCS Plan Surveys and Audits

• Performance Measures and Metrics

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Page 16: Healthy Families Program Transition to Medi-Cal October 23, 2012

Questions and Answers

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Page 17: Healthy Families Program Transition to Medi-Cal October 23, 2012

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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Page 18: Healthy Families Program Transition to Medi-Cal October 23, 2012

DHCS Information/Questions

[email protected]

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