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

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Presentation on theme: "Healthy Families Program Transition to Medi-Cal October 23, 2012."— Presentation transcript:

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

2 Vaccines for Children Program Updates Notices Federal Approval Stakeholder Engagement Review Strategic Framework 2 AGENDA

3 Vaccines for Children Program 3

4 Vaccines for Children Program Statewide Program Overview Program Enrollment Existing Providers New Providers Ordering Contact Information: 4

5 Update: Notices 5

6 6 Timing Stakeholder Engagement Medi-Cal Threshold Languages Appropriate Reading Level

7 Update: Federal Approval 7

8 Federal Approvals DHCS –Medi-Cal 1115 Waiver Amendment –Title XIX (Medi-Cal) State Plan Amendment MRMIB –Title XXI (HFP) State Plan Amendment 8

9 Update: Stakeholder Engagement 9

10 Review Strategic Framework 10

11 11 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

12 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) 12 Methods and Processes for Stakeholder Engagement

13 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) 13

14 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 14

15 State Monitoring DMHC Plan Surveys DHCS Plan Surveys and Audits Performance Measures and Metrics 15

16 Questions and Answers 16

17 Next Stakeholder Webinar Date: Friday, December 7, 2012 Time: 1:00pm to 3:00pm Location: DHCS Auditorium, 1500 Capitol Ave, Sacramento 17

18 DHCS Information/Questions Transition.aspx MRMIB Information/Questions 18 Contact Us


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