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1. What is a Medi-Cal managed care health plan?
Answer: Medi-Cal managed care health plans are like HFP health plans. They help manage your child’s care. This care includes helping you to find doctors and specialists, having a 24-hour nurse advice phone line, having member services to assist you, helping with transportation to medical visits, and more. The health plan will also help you get services your child needs that are not covered by the plan. If your child:
- Receives In-Home Support Services (IHSS), contact your social worker to find out if you can get more IHSS hours.
- Is a client of a Regional Center, contact your caseworker for assistance.
- In need of mental health services, contact your county caseworker for assistance.
2. Why does my child need to be enrolled in a Medi-Cal managed care health plan?
Answer: State law requires that individuals, who are eligible for Medi-Cal, such as families and their children, receive health care through a Medi-Cal managed care health plan (where available). As part of the HFP move to Medi-Cal, children living in counties where Medi-Cal managed care is available will be required to move into a health plan.
For dental benefits, all children, except children living in Los Angeles and Sacramento Counties, will receive their dental care through the Medi-Cal FFS dental program, known as Denti-Cal. Children in Los Angeles County will choose between Denti-Cal and a dental managed care plan. Children in Sacramento County will enroll into a dental managed care plan. (See the DENTAL SERVICES section for more information.)
3. When will my child move into a Medi-Cal managed care plan?
Answer: Your child will move into a Medi-Cal managed care health plan during one of the four phases of the HFP transition to Medi-Cal, which began on January 1, 2013. The first three phases will take place in counties that already have Medi-Cal managed care health plans, and the fourth phase takes place in counties that are currently Medi-Cal FFS only. When all four phases are complete, all children in HFP will be enrolled in Medi-Cal, either in a managed care health plan or in FFS.
The four phases are as follows:
Phase 1 – began January 1, 2013, children in a HFP plan, which is also a Medi-Cal managed care health plan will move to Medi-Cal, but will stay in the same plan. They did not need to choose a different plan. This phase had four sub-phases:
- Phase 1 Part A – on January 1, 2013, children in the following counties transitioned: Alameda, Riverside, San Bernardino, San Francisco, Santa Clara, Orange, San Mateo, and San Diego (except for Health Net managed care health plan).
- Phase 1 Part B – on March 1, 2013, children in Medi-Cal managed care health plans except for Health Net in the following counties transitioned: Contra Costa, Fresno, Kern, Kings, Los Angeles, Madera, Tulare, Sacramento, Napa, Solano, Sonoma, Yolo, Monterey, Santa Cruz, Santa Barbara, and San Luis Obispo.
- Phase 1 Part C – on April 1, 2013, children in the Health Net managed care health plan in the following counties transitioned: Kern, Tulare, Sacramento, San Joaquin, and Stanislaus.
- Phase 1 Part C – on May 1, 2013, children in the Health Net managed care health plan in the following counties transitioned: Los Angeles and San Diego.
Phase 2 – began April 1, 2013, children who are in a HFP plan which subcontracts with a Medi-Cal managed care health plan moved to Medi-Cal, but stayed in the same plan. They did not need to choose a different plan
Phase 3 – no sooner than August 1, 2013, children who are in a HFP plan, which is not a Medi-Cal managed care health plan or a subcontractor of a Medi-Cal managed care health plan, will enroll in a Medi-Cal managed care health plan of their choice. This choice must be made prior to July 23, 2013. If a choice is not made by that date, children will be automatically enrolled into a plan using a formula that tries to match them with their current provider, if there is provider linkage with a Medi-Cal manage care health plan. If there is no provider linkage, DHCS will enroll children into one of the available Medi-Cal managed care plans in the county using the current default algorithm. If a HFP plan becomes a subcontractor of a Medi-Cal managed care plan, HFP children will be able to stay in the same plan. They will not need to choose a new plan. The exceptions to this process are the County Organized Health System (COHS) counties, where there is only one Medi-Cal managed care plan operating in a county. Children who are in a HFP plan that is not also a Medi-Cal managed care plan and does not subcontract with one, and who live in a COHS county, will move into the COHS plan operating in their county. COHS counties with a Phase 3 population are Marin, Mendocino, Merced, Monterey, Napa, Orange, San Luis Obispo, San Mateo, Santa Barbara, Santa Cruz, Solano, Sonoma, Ventura, and Yolo.
Phase 4 – children who are in a HFP plan, but who do not live in a county where Medi-Cal managed care currently operates, will move into Medi-Cal FFS. If Medi-Cal managed care health plans are established in FFS counties before Phase 4 begins, HFP beneficiaries will enroll into the Medi-Cal managed care health plan of their choice, if more than one plan is available. Children who are in a HFP plan that has become a Medi-Cal managed care plan in that county, or a subcontractor of a Medi-Cal managed care plan, will be able to stay in the same plan. They will not need to choose a new plan. This phase has two sub-phases:
- Phase 4, Part A – no sooner than September 1, 2013, children in the following counties will be transitioned: Del Norte, Humboldt, Lake, Lassen, Modoc, Shasta, Siskiyou, and Trinity.
- Phase 4, Part B – no sooner than November 1, 2013, children in the following counties will be transitioned: Alpine, Amador, Butte, Calaveras, Colusa, El Dorado, Glenn, Imperial, Inyo, Mariposa, Mono, Nevada, Placer, Plumas, San Benito, Sierra, Sutter, Tehama, Tuolumne, and Yuba.
4. Will my child continue in the same vision plan?
Answer: No, your child will not be in the same vision plan, but will have vision coverage. Medi-Cal provides vision services through Medi-Cal managed care health plans or Medi-Cal FFS.
5. Will the Medi-Cal Managed Care medical, dental and vision benefits be the same as HFP benefits?
Answer: Yes, under Medi-Cal, medical, dental, and vision are all covered for children under 19 years of age. For children transitioning to Medi-Cal managed care, some services, such as dental, mental health, or substance use disorder which are offered under HFP plans may be “carved out” of the plan’s benefits, but will still be covered by Medi-Cal. The Medi-Cal managed care health plan will refer beneficiaries to Medi-Cal FFS providers for these services, if they are not covered by the plan. Please see the section on behavioral health regarding the provision of applied behavior analysis (ABA) therapy services.
6. Will my child be in the same health plan?
Answer: This depends on the county you live in and the HFP health plan your child is enrolled in. If your child moves to Medi-Cal in Phases 1 or 2, he/she will have the same plan. If your child moves to Medi-Cal in Phases 3 or 4, he/she will have to move to a new Medi-Cal Managed Care Plan (MCP) or receive his/her health, dental, and vision services through Medi-Cal FFS. If you have questions, you can call your child’s current HFP health plan at the number on your child’s health plan insurance card.
7. Can I change my child’s Medi-Cal health provider or plan?
Answer: Once your child has moved to Medi-Cal, you can choose another Medi-Cal managed care health plan, if there is more than one plan in your county. You can also change your child’s primary care doctor and choose any available doctor within your child’s Medi-Cal managed care health plan network. These changes can happen monthly.
8. How can I enroll my child into a different Medi-Cal managed care health plan?
Answer: Once your child moves to Medi-Cal, you can do the following:
Department of Health Care Services
Health Care Options
P.O. Box 989009
West Sacramento, CA 95798-9850
9. Will my child be able to see the same primary care provider after he/she transitions to the Medi-Cal program?
Answer: If your child’s HFP provider is not already in a plan’s Medi-Cal network and agrees to join the network, then your child can continue to see this provider with no interruptions. If the provider does not join a plan’s Medi-Cal network, but is willing to work with the plan to continue treating your child, the Medi-Cal managed care health care plan must allow your child continued access to the provider for up to 12 months. If the provider will no longer see your child after the transition to Medi-Cal, then the Medi-Cal managed care health plan must develop a strategy to ensure that there is no break in your child’s treatment or access to services. The Medi-Cal managed care health plan must submit this strategy to DHCS for tracking to help ensure your child is able to continue services and access to providers he/she needs.
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