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Previous Next Beginning End 1 Medi-Cal Redesign Stakeholders Meeting.

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Presentation on theme: "Previous Next Beginning End 1 Medi-Cal Redesign Stakeholders Meeting."— Presentation transcript:

1 Previous Next Beginning End 1 Medi-Cal Redesign Stakeholders Meeting

2 Previous Next Beginning End 2 AGENDA Welcome and Opening Comments –Kim Belshé, Health and Human Services Secretary Proposal Overview, Timeframes, and Stakeholders Sessions –Stan Rosenstein, Deputy Director, Medical Care Services, Department of Health Services Questions and Answers –Tom McCaffery, Chief Deputy Director, Department of Health Services

3 Previous Next Beginning End 3 Welcome and Opening Comments Secretary Kim Belshé

4 Previous Next Beginning End 4 Overview, Timeframe, and Stakeholders Sessions Stan Rosenstein

5 Previous Next Beginning End 5 Medi-Cal Redesign Goals Protect eligibility for those people currently eligible Maintain essential services and align coverage with private sector Continue services to children as a Medi-Cal priority Increase the personal responsibility of Medi-Cal beneficiaries by requiring they share in the cost of services

6 Previous Next Beginning End 6 Medi-Cal Redesign Goals Continued… Promote work participation by continuing coverage of the working poor and allowing people to continue to maintain Medi-Cal coverage while their work income increases Improve program effectiveness and accountability by promoting organized delivery systems

7 Previous Next Beginning End 7 Medicaid Demonstration Waiver Provide California with the flexibility to redesign Medi-Cal, allowing it to continue to maintain coverage of people current eligible, provide essential care, and be affordable to the State Other states have done waivers to gain more flexibility in the operation of their Medicaid programs, examples include Oregon and Utah California’s first comprehensive waiver

8 Previous Next Beginning End 8 Potential Components of Redesign Various options for redesign are being considered Final proposal will be developed after discussions with Stakeholders and Legislature

9 Previous Next Beginning End 9 Simplify Medi-Cal Eligibility Concept: Align Medi-Cal’s eligibility standards and processes for families and children with those of CalWORKs Use Medi-Cal rules for the Aged, Blind, and Disabled Simplify the determination of financial responsibility of parent-for-child and spouse- for-spouse will be simplified

10 Previous Next Beginning End 10 Simplify Medi-Cal Eligibility Continued… Rationale Medi-Cal is an excessively complex array of eligibility standards and programs and, consequently, costly and confusing to administer Redesign will simplify the program for beneficiaries and counties

11 Previous Next Beginning End 11 Modify Benefit Structure Concepts: Multi-tiered Benefit Structure –Full scope Medi-Cal benefits for newly defined mandatory eligibles –Full scope benefits for all eligible children –A basic benefit package for optional eligibles with greater beneficiary cost sharing –A more comprehensive benefit package for optional eligibles that want to pay a larger monthly premium

12 Previous Next Beginning End 12 Modify Benefit Structure Continued… Make services more consistent with private insurance and other Medicaid programs –Establish premiums for optional beneficiaries –Create a meaningful co-pay program with optional beneficiaries having greater cost sharing. –Gain control over program expenditures by redefining the medical necessity standard for benefits for children

13 Previous Next Beginning End 13 Modify Benefit Structure Continued… Rationale Benefit restructuring will enable the State to continue to maintain coverage of people currently eligible, provide essential care, and better control program costs. It will promote a more cost effective utilization and delivery of Medi-Cal Services by beneficiaries and providers

14 Previous Next Beginning End 14 Modify Delivery Systems Concept: Expand mandatory enrollment for parents and children to additional counties Broaden utilization of organized delivery systems for the aged, blind, and disabled (ABD) population Rationale: Better access to providers, coordination of care, improved quality of care, and reduced preventable hospitalizations.

15 Previous Next Beginning End 15 Timetables

16 Previous Next Beginning End 16 Timetable Medi-Cal Redesign January 2004 Start stakeholders meetings and continue throughout the process May 2004 Waiver concept paper submitted to the Legislature July 2004 Obtain budget trailer bill language to implement October 2004 Submit waiver to CMS

17 Previous Next Beginning End 17 Timetable Medi-Cal Redesign Continued December 2004 CMS approval of waiver December 2004-June 2005 County and system changes July 2005 through June 2006 Phased in waiver implementation

18 Previous Next Beginning End 18 Future Stakeholders Meetings Next introductory meeting in Los Angeles (TBA) Divide into work groups –Eligibility –Benefits and Beneficiary Cost Sharing –Managed Care Monthly meetings during waiver development Please volunteer for a work group Public hearings on waiver before final submission

19 Previous Next Beginning End 19 Additional Questions & Comments If you have additional questions and/or comments, please them to


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