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Healthy Families Program Transition to Medi-Cal September 13, 2012.

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Presentation on theme: "Healthy Families Program Transition to Medi-Cal September 13, 2012."— Presentation transcript:

1 Healthy Families Program Transition to Medi-Cal September 13, 2012

2 Update: Network Adequacy 2

3 Requests for health and dental plan provider network data: Sent to plans August/early September Health and dental plan responses: Due September 14 DMHC and DHCS joint review and evaluation of data Network adequacy assessment: Provide to Legislature 60 days prior to the start of Phase 1 3

4 Update: HFP Subscriber General Notice 4

5 Notices 5 HFP Notices: General Notice, 90-Day, 60-Day, 30-Day. Medi-Cal “Welcome” notice post-transition. Stakeholder engagement for notices. Will translate in the Medi-Cal threshold languages. Center for Health Literacy will review for Reading Level.

6 Review Draft Strategic Plan Due: October 1,

7 Program Overview and Legislative Requirements Transfer HFP subscribers to Medi-Cal no sooner than January 1, 2013, over 4 phases Strategic Plan due October 1, 2012 Certify Phase 1 network adequacy November 1, 2012 Submit Implementation Plans 60 days prior to start of each phase Monthly ongoing reporting commencing February 15,

8 8 Goals of Transition Facilitate a smooth transition Minimize disruption in services Maintain eligibility gateways Ensure access to care Ensure continuity of care Program Overview and Legislative Requirements

9 9 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 Summary of Phases

10 Key Activities for Phase 1 Planning –Review and Analysis of Provider Network Review Data from Plans (health and dental) –All County Welfare Director Letter Reviews with Stakeholders and Counties; Release of 2 nd drafts –DHCS IT, MCED, Counties, Consortia and MAXIMUS determine data transfer protocols –Welcome Package review with stakeholders –State Plan/Waiver Amendment development and submission –Provide Strategic Plan to Legislature by October 1, 2012 –Deliver Certification of Network Adequacy to the Legislature by November 1,

11 Committed to collaboration and coordination of transition Ensure transparency and public/stakeholder engagement in the process DHCS Managed Care, Eligibility, and Dental Division Stakeholder Meetings MRMIB Monthly Board Meetings, CAA Network, HFP Advisory Panel DMHC Quarterly Plan and Advocate Meetings Combined Webinars, Children’s Groups, and Small Stakeholder Groups 11 Communication

12 Eligibility and Enrollment Outreach to Subscribers/Families –General Notice, and 90, 60, 30 Day Notices for Each Phase –What We Tell Families Grid County Coordination –Eligibility Determinations –Eligibility Data Reports and Performance Standards MAXIMUS Coordination –Cost-Sharing: Premium Management and Co- Payments 12

13 Health and Dental Plan Transition Health Plans –Network Adequacy –Continuity of Care Dental Plans and Fee-for-Service –Network Adequacy –Continuity of Care –Fee-for-Service Provider Enrollment 13

14 Health and Dental Plan Transition Performance Measures Health Plans –Child-Only HEDIS Measures –Ongoing Network Adequacy –Beneficiary Satisfaction Surveys Dental Plans and Fee-for-Service 14

15 Health and Dental Plan Transition DMHC Oversight Pre- and Post-Transition Network Adequacy Assessments Ongoing Fiscal Solvency Examinations, Medical Surveys, and Transition-Related Health Plan Filings DMHC Help Center 15

16 Federal Approvals DHCS –Title XIX (Medi-Cal) State Plan Amendment –Medi-Cal 1115 Bridge to Reform Waiver MRMIB –Title XXI (HFP) State Plan Amendment 16

17 Considerations for Input Is any additional content needed? Have all key areas been addressed? Are there any major omissions of information? What are suggested changes to the layout of the plan? What data elements should be included? 17

18 Next Steps 5:00 PM, Thursday, September 20, 2012 –Deadline to Submit Comments on Draft Strategic Plan Upcoming Stakeholder Webinars –2 – 4pm, Tuesday, October 23, 2012 –1 – 3pm, Friday, December 7,

19 Questions and Answers 19

20 DHCS Information/Questions DHCS Healthy Families FamiliesTransition.aspx MRMIB Information/Questions 20 Contact Us


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