1. Member Driven. Patient Focused. SB 75 Health4All Kids Update Outreach, Enrollment & Retention Peer Network Community Clinic Association of Los Angeles County Last updated May 6, 2016

2. Member Driven. Patient Focused. Senate Bill (SB) 75 was a June 2015 budget bill that provides DHCS with the authority to make available full scope Medi-Cal benefits to children under age 19, up to 266 percent of the Federal Poverty Level (FPL), who do not meet satisfactory immigration status, but do meet all other eligibility requirements for Medi-Cal. – SB 75 will be implemented no sooner than May 1, 2016; the final “go-live” date will depend on systems readiness. SB 4 by Senator Lara was known as the “Health4All” bill. The version of SB 4 signed by the Governor in October 2015 contains implementation instructions for SB 75. SB 75 and SB 4

3. Member Driven. Patient Focused. Statewide Eligible Population DHCS estimates 170,000 undocumented children under the age of 19 will be newly eligible for full scope Medi-Cal – Approx. 115,000 children are currently enrolled in restricted-scope Medi-Cal statewide Other estimates of the newly eligible population are as high as 300,000 children statewide

4. Member Driven. Patient Focused. LA County Estimates 10,000 children in My Health LA (MHLA) 500 in the L.A. Care Healthy Kids Plan 16,000 in the Kaiser Child Health Program 45,000 enrolled in restricted scope Medi-Cal There is overlap! An unknown number of children are simultaneously enrolled in restricted scope Medi-Cal AND MHLA, Healthy Kids or the Kaiser program.

5. Member Driven. Patient Focused. Implementation Timeline

6. Member Driven. Patient Focused. Systems Changes SB 75 will be implemented “no sooner than May 1, 2016”. This is specified in the law. The final “go-live” date will depend on systems readiness (CalHEERS & SAWS) The Medi-Cal application channels, processes and documentation requirements will not be different for this population; the systems will just be programmed to find these children full scope eligible instead of restricted scope.

7. Member Driven. Patient Focused. Systems Changes California Healthcare Eligibility, Enrollment and Retention System (CalHEERS) must be updated to determine full scope eligibility for children who will be eligible under MAGI rules – CalHEERS updates are scheduled to go-live on May 16 County SAWS systems (LEADER in Los Angeles) must be updated to determine full scope eligibility for children who will be eligible under non-MAGI rules and to implement the processes to transition children from restricted scope to full scope Medi-Cal – SAWS changes are scheduled to be ready for May 16

8. Member Driven. Patient Focused. Implementation Plan Transition population: Children enrolled in restricted scope Medi-Cal at the time of the transition will be transitioned to full scope aid codes; no new application will be needed. New enrollee population: Children not enrolled in restricted scope Medi-Cal will need to go through the regular Medi-Cal application process for enrollment. Applications In-Progress: Any Medi-Cal application that is started in CalHEERS and does not have an eligibility determination at the time of the transition will be adjudicated using the updated SB 75 eligibility rules.

9. Member Driven. Patient Focused. Transition Population: Process Go live for system updates is slated for May 16 DPSS will transition eligible cases from restricted to full scope aid codes over several days following May 16 Children will be transitioned into the full scope aid code that corresponds with their current restricted scope aid code (see aid code crosswalk) (No new aid codes) aid code crosswalk Effective date for Medi-Cal coverage will be the start of the month (eg. if transition “go-live” is May 16, Medi-Cal coverage will be for the full month of May, starting May 1) If implementation is delayed, the eligibility effective date will change. Eg. If delayed into June, the effective date would be June 1, 2016.

10. Member Driven. Patient Focused. Transition Population: DPSS Process When systems are ready, the LA County Dept. of Public and Social Services’ responsibilities include: Identify children enrolled in restricted-scope MAGI aid codes and process needed transition steps to full-scope Medi-Cal via CalHEERS Identify children enrolled in restricted-scope non-MAGI aid codes and transition cases to full-scope Medi-Cal via SAWS Generate and send second notice (Notice of Action) LA County’s LEADER/LRS systems will perform automated batch transactions over two to three nights following May 16

11. Member Driven. Patient Focused. Transition Population: Notices First Notice (Mailed April 15): General outreach letter to children in restricted scope Medi-Cal, containing information about the upcoming change, including covered benefits and managed care enrollment.outreach letter Second Notice (at transition): Notice of Action (NOA) that tells beneficiary they have been changed from restricted scope to full scope Medi-Cal coverage. Third Notice (approx. 3-5 days after transition): Medi-Cal managed care health plan enrollment information and instructions. Health Plan Choice Packet (following 3 rd notice): Health Care Options “choice packet” advising beneficiaries to choose their plans and providers.

12. Member Driven. Patient Focused. Transition Population: Health Plan Selection Beneficiaries will be fee-for-service until they select a Medi- Cal managed care health plan Soon after the transition to full scope aid code, beneficiaries will receive the Health Care Options (HCO) Choice Packet to select a Medi-Cal managed care plan and provider DHCS has advised that beneficiaries can call HCO once they have full scope eligibility and select a plan over the phone – they do not have to wait for the HCO packet Clinics should consider educating patients on how to complete the HCO form (or how to get help completing the form) so they can keep their same doctor/medical home.

13. Member Driven. Patient Focused. New Enrollee Population Once system changes are complete and the state gives the green light, newly eligible children who were not part of the transition population will be able to apply for full scope Medi-Cal via the regular application portals and processes: – CalHEERS/Covered CA – Your Benefits Now (LA County portal) – Add to existing family case using MC 371 form – County/DPSS office

14. Member Driven. Patient Focused. Children Turning 19 Individuals who turn 19 on or before May 1, 2016 will be considered to be age 19 for the month of May and will not be eligible for full scope coverage under SB 75. Individuals who turn age 19 between May 2 through May 31, 2016 are considered to be age 18 for the month of May and will be transitioned to full scope Medi-Cal effective May 1, 2016. Individuals turning 19 within six months of the transition date will be enrolled into FFS full scope Medi-Cal. They are not required to enroll into a manage care plan but may do so voluntarily. When children turn 19 they will no longer be full scope Medi-Cal eligible. They will revert to restricted scope and will need to newly apply for MHLA (if disenrolled).

15. Member Driven. Patient Focused. Continuity of Care Processes for requesting for Continuity of Care and Medical Exemption are the same for this newly eligible population as for any other Medi-Cal beneficiary Information about continuity of care is available on the DHCS websiteDHCS website DHCS (the state) will post a Provider Bulletin prior to the transition LADHS will provide training/information to their providers so they are aware

16. Member Driven. Patient Focused. My Health LA (MHLA) There is no direct transition of children from MHLA to Medi-Cal. A motion by the LA County Board of Supervisors on May 3 directed LADHS to change its plan for disenrolling children from MHLA. – Previously: The MHLA Program planned to disenroll all children once they were Medi-Cal eligible after May 16. All children would have been disenrolled by the end of May. – Now: Children may remain enrolled in MHLA until DHS can determine that they have full scope Medi-Cal, or until December 31, 2016, whichever is sooner.

17. Member Driven. Patient Focused. My Health LA (MHLA) Children will stay enrolled in MHLA until LADHS can determine that they have full scope Medi-Cal, or until December 31, 2016, whichever is sooner. LADHS will work with DPSS to determine which MHLA children have successfully enrolled in full scope Medi-Cal. – Mechanisms and process for this have not yet been determined Effective May 26, the One-e-App enrollment system will no longer approve new applications for individuals under age 19.

18. Member Driven. Patient Focused. MHLA Communication Plan The MHLA Program is communicating with beneficiaries regarding SB 75 changes via the MHLA Participant Newsletter – The first information to beneficiaries was in the late March newsletter The MHLA Program is communicating with Community Partner (CP) clinics via the CP Connection newsletter Children will receive a Notice of Action when they are disenrolled from MHLA

19. Member Driven. Patient Focused. What should clinics do now? Keep children enrolled in MHLA! – Children should stay enrolled in MHLA, and should renew their MHLA when due (they will be notified when they are disenrolled). – Take advantage of renewals to educate families and help them enroll children into Medi-Cal. – LADHS will be processing the disenrollment of children from the program, beneficiaries and/or enrollers should not need to take action from their end. – Instructions will be communicated to Community Partner clinics and enrollers.

20. Member Driven. Patient Focused. What should clinics do now? Continue submitting Medi-Cal applications for newly eligible children. Any Medi-Cal application that is started in CalHEERS and does not have an eligibility determination at the time of the transition will be adjudicated using the updated SB 75 eligibility rules. After May 16 children will be applying for full scope Medi-Cal, just like any other Medi-Cal applicant. Remember that not only MHLA children are newly eligible for full scope, children with family income up to 266% FPL are eligible – There is a monthly premium for children over 160% FPL: $13 per child per month, no more than $39/month per family).

21. Member Driven. Patient Focused. What should clinics do now? Help Prevent Duplicate Medi-Cal Applications! – If a family/household member already has a Medi-Cal case (eg. sibling) the child does NOT need to submit a new Medi-Cal application! They can add to the existing case! – Duplicate applications WILL delay processing. – Proper screening is key! Ask questions. Use MEDS if you have access. If applicable, request assistance from out- stationed DPSS eligibility workers. – A child can add to an existing case using MC 371 formMC 371 Best Practice: Email the form to the DPSS advocate liaison at the district carrying the family’s case along with the necessary documents (ID or MC13 and immigration papers if needed). Then the enroller can follow up directly with the liaison and will have an e-mail trail.

22. Member Driven. Patient Focused. What about the Healthy Kids Program? For children currently enrolled in L.A. Care’s Healthy Kids program the process is much the same as for MHLA children – Children enrolled in the Healthy Kids program who also have restricted scope Medi-Cal will transition on May 16 – Children who are not currently enrolled in restricted scope will have until December 2016 to enroll The Healthy Kids program is expected to close in December 2016.

23. Member Driven. Patient Focused. What about Kaiser’s Child Health Plan ? For children currently enrolled in Kaiser’s Child Health Plan the process is much the same – Children enrolled in the Kaiser program who also have restricted scope Medi-Cal will transition May 16 – Children not currently enrolled in restricted scope are expected to have until December 2016 to enroll in full scope Medi-Cal – Beneficiaries will be able to select Kaiser as their Medi-Cal plan if they wish (they will receive instructions) The Kaiser Child Health Plan will remain open for children with family income between 267-300% FPL.

24. Member Driven. Patient Focused. Outreach and Education The California Endowment’s Health4All Niños materials are now available: – To request booklets (English and Spanish), add your organization name and shipping information to this Google documentGoogle document – The “5 Things You Need to Know” flyer is available here in English, Spanish, Arabic, Khmer, Somali, Thai and Vietnamese.here – The “5 Steps to Enroll” flyer is available here in English and Spanish.here A coalition of California children, immigrant, and health advocates and organizations recently launched a new Health4Allkids.org website and toolkit Health4Allkids.orgtoolkit

25. Member Driven. Patient Focused. Questions? Please contact: Joanne Preece, Policy Analyst Community Clinic Association of Los Angeles County jpreece@ccalac.org