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Seniors and Persons with Disabilities Imperial County and Regional Model 2014 Transition Questions and Answers

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 Does this affect me? 

This change will affect you based on the county you live in, the type of AID code (eligibility) you have, and if you have Medicare coverage.

Seniors and persons with disabilities (SPD) who reside in one of the following counties will be affected by this change:  Alpine, Amador, Butte, Calaveras, Colusa, El Dorado, Glenn, Imperial, Inyo, Mariposa, Mono, Nevada, Placer, Plumas, Sierra, Sutter, Tehama, Tuolumne, and Yuba.

If you reside in one of the above counties and have one of the following SPD AID codes, you will  be affected by this change: 20, 24, 26, 2E, 2H, 36, 60, 64, 66, 6A, 6C, 6E, 6G, 6H, 6J, 6N, 6P, 6V, 10,14, 16, 1E, 1H.

A member eligible for both Medicare and Medi-Cal, also known as a Dual Eligible, will not be affected by this change.  For a list of other conditions that would exclude you from this change, see: 

Who is not affected by this?   

Beneficiaries in any of the above categories who receive health care services through Fee-for-Service (FFS) Medi-Cal will be required to join a health plan soon. SPDs currently in a health plan will no longer have the option to choose FFS Medi-Cal. To get more details, choose a health plan, or to change health plans at any time, go to the Health Care Options' website. For information on accessibility and how to see your Medi-Cal provider, go to: Accessibility and How to See Your Medi-Cal Provider.

​Voluntary Enrollment ​Excluded Enrollment
SPDs will remain voluntary if they belong to one or more of the following groups:
  • Dual Eligibles, or those with Medicare
  • Foster Children
  • California Children's Services (CCS)
  • SPDs residing in San Benito County​
​SPDs are excluded from enrolling in a managd care plan if any of the following categories apply:
  • Major Organ Transplants
  • Identified as Long Term Care (LTC)
  • Share of Cost Medi-Cal
  • Those with Other Health Coverage

 

What is the enrollment process?   

Effective December 1, 2014, seniors and persons with disabilities (SPD) will be mandatorily enrolled into managed care.  In early September 2014, SPDs began receiving notification letters, choice packets, informational materials, and phone calls from people who can help with  enrollment. To get more details, choose a health plan, or to change a health plans, see How do I choose a Health Plan? How do I change health plans?, or visit Health Care Options' website.

How will I be notified?  

Medi-Cal only SPDs began receiving letters in the mail in early September.  Additional material will be sent in early October and early November.  Phone calls will be made in October and November.  These notifications will both educate members on the process of this change to their Medi-Cal coverage as well as give them an opportunity to select a health plan for their health care services.
 

How do I choose a health plan?  

SPDs may choose their health plan in a number of ways. Please note that you will no longer have the option to choose Fee-for-Service (FFS) Medi-Cal. SPDs can make a choice online by going to Health Care Options' website or by calling Health Care Options at 1-800-430-4263. SPDs can also choose a health plan by filling out a health plan choice form that will be sent in the mail. SPDs will also have the opportunity to choose a plan over the phone when they are called regarding their health plan enrollment.

How do I change health plans?  

SPDs may change their health plan at any time. SPDs can make a change online by going to the Health Care Options' website or by calling Health Care Options at 1-800-430-4263.

Will my health benefits change?  

All health care benefits and services that were covered before will stay the same.

If I am already in a health plan, do I need to do anything?   

If you are already in a managed care health plan you will not need to do anything, and services will not change.

What about Long Term Care?  

SPDs currently in Long Term Care (LTC) will not be mandatorily enrolled into managed care. SPDs currently enrolled in a managed care plan entering LTC will be disenrolled and placed into Fee-for-Service (FFS) Medi-Cal after the first two months since the health plan is only responsible for the month of admission and the month after admission. The health plan must be notified immediately if an SPD in LTC is incorrectly enrolled into managed care in order to start the disenrollment process from the health plan and into FFS Medi-Cal.

If I have more questions, who do I contact?  

If you have more questions regarding the changes in Medi-Cal, and how they affect you, you can contact Health Care Options by going to Health Care Options' website or by calling Health Care Options at 1-800-430-4263. Any further questions or comments can be sent to mmcd.tpgmc@dhcs.ca.gov

Were you seeing a Medi-Cal doctor before enrolling into a health plan?  

 

Is there a doctor that will meet my accessibility needs?   

Last modified on: 11/25/2014 2:21 PM