Presentation on theme: "California’s Coordinated Care Initiative July 2014."— Presentation transcript:
California’s Coordinated Care Initiative July 2014
Roadmap About the Coordinated Care Initiative Cal MediConnect Medi-Cal Managed Long Term Services and Supports Timeline and Enrollment Participating in Cal MediConnect Additional Resources 2
The Coordinated Care Initiative: Where San Bernardino Riverside San Diego AlamedaSan Mateo Santa Clara Los Angeles Orange* 3 *Participation in Orange County pending readiness reviews.
Medicare Doctors Hospitals Prescription drugs Medi-Cal 4 Medicare and Medi-Cal Today Who: 65+, under 65 with certain disabilities Who: low-income Californians Long-term services and supports MSSP: Multipurpose Senior Services Program IHSS: In-Home Supportive Services CBAS: Community-Based Adult Services Nursing facilities Durable medical equipment Medicare cost sharing
Cal MediConnect Optional Combines Medicare and Medi-Cal benefits into one managed care health plan Additional services, including care coordination Medi-Cal Managed Long-Term Services and Supports (MLTSS) 5 The Coordinated Care Initiative: Two Parts Mandatory Beneficiaries will now receive Medi-Cal benefits through a managed care health plan, including LTSS and Medicare wrap-around. Who: many full dual eligible beneficiaries Who: Medi-Cal only beneficiaries, full dual eligibles who opt out of Cal MediConnect, other identified groups eligible for Medi-Cal
6 Cal MediConnect Who: Medi-Medi beneficiaries Optional Original Medicare and Medi- Cal services One number for all your health care needs Vision benefit: one routine eye exam annually and a $100 co-pay for eye glasses/contacts every two years Transportation benefit: 30 1- way trips per year in addition to the existing transportation benefit Care Coordination
7 Cal MediConnect plans will give providers information and resources to support care coordination. Health Risk Assessments (HRAs) Primary, acute, LTSS, behavioral health and functional needs Interdisciplinary Care Teams Beneficiary, plan care coordinator, key providers Individualized Care Plans Care teams will develop and implement ICPs Plan Care Coordinators Facilitates communication between plans, providers, beneficiary Cal MediConnect Care Coordination
Care Coordination: Example Patient X recently had a stroke and is back living at home. 8 Before Cal MediConnect, the patient would have to navigate Medicare, Medi- Cal and county agencies to get needed social services – often relying on their doctor’s office staff for help. Under Cal MediConnect, a plan care coordinator will ensure the patient has: Transportation to appointments Coverage for prescriptions Meals on Wheels Other support for activities of daily living
9 You can combine your Medicare A, B & D with your Medi-Cal benefits into a Cal MediConnect plan Select one of the participating Cal MediConnect plans in your county If you have Medicare and Medi-Cal Option 1: Choose Cal MediConnect
10 *Participation in Orange County pending readiness reviews. Los Angeles Care1st, CareMore, Health Net, LA Care and Molina Health Orange* CalOptima San Diego Care 1 st, Community Health Group, Health Net and Molina Health San Mateo Health Plan of San Mateo Alameda Alameda Alliance and Anthem Blue Cross Santa Clara Anthem Blue Cross and Santa Clara Family Health Plan San Bernardino Inland Empire Health Plan and Molina Health Riverside Inland Empire Health Plan and Molina Health Cal MediConnect Plan Options
11 People not eligible for Cal MediConnect You can’t join Cal MediConnect if you: Are younger than 21. Receive developmental disability waiver services from a Regional Center. Do not meet your Medi-Cal share of cost, if you have one. Have End-Stage Renal Disease (ESRD), except in San Mateo County. Have other health coverage, such as retirement, veterans or private coverage. Live in a veterans home. Receive services through one of the following waiver programs; Nursing Facility/Acute Hospital, HIV/AIDS, Assisted Living, or In Home Operations ( you must disenroll from these programs to enroll in Cal MediConnect, you will not be passively enrolled ). Are enrolled in PACE (you must disenroll to be eligible for the Cal MediConnect; will not be passively enrolled). Live in some rural zip codes in Los Angeles, Riverside and San Bernardino Counties.
12 Medi-Cal Managed Long-Term Services and Supports Who: Medi-Cal only beneficiaries, full dual eligibles who opt out of Cal MediConnect, other identified groups eligible for Medi-Cal Mandatory Same Medi-Cal services beneficiaries currently receive Hearing aids Bathrooms aids (grab bars, shower chairs) Non-emergency medical transportation (wheelchair vans and litter vans) Incontinence supplies Medi-Cal long-term services and supports (MLTSS) will now be coordinated by a managed care plan MSSP: Multipurpose Senior Services Program IHSS: In-Home Supportive Services CBAS: Community-Based Adult Services Nursing facilities
13 Your Medicare including your Part D plan, will stay the same You will continue to use the same Medicare providers Your Medi-Cal benefits are now assigned to the Medi-Cal health plan If you have Medicare and Medi-Cal Option 2: Keep your Medicare as it is and join a Medi-Cal health plan Enroll in only a Medi-Cal Plan Select one of the participating Medi-Cal plans in your county
14 If you have only Medi-Cal You must choose a Medi-Cal plan for your Medi-Cal benefits Enroll in a Medi-Cal Plan Select one of the participating Medi-Cal plans in your county
15 *Participation in Orange County pending readiness reviews. Los Angeles Health Net (Molina), LA Care (Anthem, Care 1 st, Kaiser) Orange* CalOptima San Diego Care 1 st, Community Health Group, Health Net, Molina, and Kaiser San Mateo Health Plan of San Mateo Alameda Alameda Alliance and Anthem Blue Cross Santa Clara Anthem Blue Cross and Santa Clara Family Health Plan San Bernardino Inland Empire Health Plan (Kaiser) and Molina (Health Net) Riverside Inland Empire Health Plan (Kaiser) and Molina (Health Net) MLTSS Plan Options
16 PACE Program of All-inclusive Care for the Elderly Who: Medi-Medi beneficiaries and Medi-Cal beneficiaries Option available to those who are determined eligible If you: Are 55 or older Live in your home or community setting safely Need a high level of care for a disability or chronic condition Live in a ZIP code served by a PACE health plan You may be eligible to enroll in a PACE program
17 PACE Plans Los Angeles Altamed Senior BuenaCare and Brandman Centers for Senior Care Orange* CalOptima PACE San Diego St. Paul’s PACE Alameda Center for Elders’ Independence and On Lok Lifeways Santa Clara On Lok Lifeways San Bernardino InnovAge PACE Riverside InnovAge PACE
When to Expect Notices Beneficiaries will receive notices 90, 60, and 30 days prior to your coverage date. For most people their coverage date is the first day of their birth month. Cal MediConnect official information from the state will only arrive in blue envelopes. 18
General Timeline April 2014 Enrollment in San Mateo May 2014 Enrollment in San Diego, Riverside, and San Bernardino begins July 2014 Enrollment in Los Angeles begins* January 2015 Enrollment in Alameda, Santa Clara, and Orange begins* 19 *Enrollment in Orange County and select Los Angeles plans pending readiness reviews.
Timeline Specifics Individuals who receive passive enrollment notices: Already in Managed Medi-Cal – enroll/benefit added in 1 month Not in Managed Medi-Cal – enroll by birth month In CCI-health plan DSNPs – enroll in one month in January 21
Timeline Specifics Individuals who are eligible for Cal MediConnect but WILL NOT receive passive enrollment notices: Enrolled in non-CCI plan DSNP Enrolled in Medicare Advantage Enrolled in VA, waiver system, etc. These populations will be asked to selected a Managed Medi-Cal (MLTSS) plan. 22
Cal MediConnect Notices 24 90 Day Notice 60 Day Notice 30 Day Notice
MLTSS 25 90 Day Notice 60 Day Notice 30 Day Notice
Choice Form Section 3: Cal MediConnect Plan To select a Cal MediConnect plan, complete section 3 ONLY. Section 5: Medi-Cal Plan To “Opt-Out” of Cal MediConnect, fill out section 5 ONLY. Choose the Medi-Cal plan you are already in or select the Medi-Cal plan you want to join. Section 7: PACE Plans To select a PACE plan complete section 7 AND also complete section 3 OR 5 as back-up options. 26
Use the Choice Form to Choose the Plan you Want If you have both Medicare and Medi-Cal and you do nothing: You will be assigned to a Cal MediConnect plan that is the best match for you. If you have only Medi-cal and you do nothing: You will be assigned to a Medi-Cal plan that is the best match for you. This way you will not lose your Medicare or Medi-Cal benefits or services. 27
Enrollment: Health Care Options 28 Call Health Care Options to: Enroll in a Cal MediConnect plan, or Enroll in a Medi-Cal plan (and keep your Medicare as it is today), or Enroll in a PACE plan 1-844-580-7272
Enrollment 29 The use of independent agents/brokers will not be permitted and all MMP enrollment transactions must be processed by the State enrollment broker (Health Care Options). If an individual is cross walked into a Cal MediConnect plan in some cases the broker may still receive payment from the health plan.