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Overview and Children’s Advocates’ Response The Healthy Families Program Transition into Medi-Cal Kristen Golden Testa Director, CA Health Program The.

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Presentation on theme: "Overview and Children’s Advocates’ Response The Healthy Families Program Transition into Medi-Cal Kristen Golden Testa Director, CA Health Program The."— Presentation transcript:

1 Overview and Children’s Advocates’ Response The Healthy Families Program Transition into Medi-Cal Kristen Golden Testa Director, CA Health Program The Children’s Partnership LA Collaborative October 31, 2012

2 Budget Decision The Governor’s 2012/12 budget to eliminate Healthy Families Program (HFP) and transfer all HFP enrollees to Medi-Cal Legislature adopted with oversight requirements and allowed for a flexible start date, no sooner than January 1, 2013.

3 Transition Basics All HFP children transfer to Medi-Cal Children above 150% FPL income charged premiums Transition in 2013 over phases based on county health plans comparability to HFP

4 Phases of the Transition Phase 1 (DHCS timeline: January and March 2013) Part A counties (208,376 kids): Alameda, Riverside, San Bernardino, San Francisco, Santa Clara, Orange, San Mateo, San Diego Part B counties (185,714 kids) : Contra Costa, Fresno, Kern, Kings, Los Angeles, Madera, Tulare, Sacramento, Napa, Solano, Sonoma, Yolo, Monterey, Santa Cruz, Santa Barbara, San Luis Obispo Phase 2 ( 261,060 kids ; After April 1, 2013 ) Phase 3 ( 152,602 kids; After August 1, 2013 ) Phase 4 ( 42,753 kids; After September 1, 2013 )

5 Implementation Process Flexible transition start dates (but DHCS committed to January start date) Legislative oversight: Strategic plan; Implementation plans for each phase; Network Adequacy Assessment Stakeholder engagement Notices to Families Federal CMS approval

6 Transition Issues: Enrollment 1. Sufficient notice to families about the transfer with “first responders” (counties, CAAs, doctors, teachers, etc) ready to respond 2. Transitioning children transferred without gaps or having to provide additional information 3. Not charged premiums if MC income level is below 150% 4. New applicants should all receive AE

7 What Families Should Expect General notice 60- and 30-day notices for Phase 1 90-, 60-, and 30-day notices for Phases 2-4 Medi-Cal welcome packet Benefit Identification Card (BIC) Packet from managed care plan (and dental managed care plan, where relevant)

8 Transition Issue: Realistic Timeline 1. Flexible transition start date 2. Implementation plan needed 3. Sequence essential steps. Prior to sending notices: 1. Federal approval 2. Eligibility policies finalized 3. Network adequacy assessment reviewed 4. Outreach and information to “first responders”

9 Transition Issue: Access 1. Health plan network adequacy assessment: public review and contingency plans 2. Direct provider participation survey 3. Ongoing monitoring

10 Transition Issue: Federal Approval 1115 Waiver for transition Network Adequacy approval Eligibility and enrollment approval Premium approval

11 Transition Issue: Performance HFP Transition performance standards: Did children transfer without gaps Were they able to continue care How did their access compare Baseline comparison to transition

12 Taking Action To CHHS: Not ready for January 1, more reasonable timeline Performance measures needed Plans for improving access and continuity of care Local feedback on readiness and needs on the ground To Legislature: Ensure transition readiness and children can see their doctor/dentist before transition begins.

13 Key Upcoming Dates November 1: Network adequacy assessment released and 60-day notice to families Upcoming Stakeholder Webinars: December 7, 1-3pm Federal waiver submission and approval?

14 Key Websites on the Transition MRMIB tion.html tion.html DHCS lthyFamiliesTransition.aspx lthyFamiliesTransition.aspx

15 For More Information TCP’s Website: Contact me: Kristen Golden Testa


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