Seniors & Persons with Disabilities (SPD) Regional and Imperial Model Implementation
A federal waiver granted under Section 1115(a) of the Social Security Act permits mandatory enrollment of Medi-Cal only seniors and persons with disabilities (SPD) into Medi-Cal managed care. The waiver allows the Department of Health Care Services (DHCS) to achieve care coordination, manage chronic conditions better, and improve health outcomes. Mandatory enrollment began December 2014.
Counties Included in this Change to Medi-Cal
On December 1, 2014, the following counties transitioned SPD beneficiaries into managed care plans: Alpine, Amador, Butte, Calaveras, Colusa, El Dorado, Glenn, Imperial, Inyo, Mariposa, Mono, Nevada, Placer, Plumas, Sierra, Sutter, Tehama, Tuolumne, and Yuba.
Aid codes included in this change to Medi-Cal
Those with one of the following aid codes will be included in this transition into managed care, beginning December 1, 2014: 20, 24, 26, 2E, 2H, 36, 60, 64, 66, 6A, 6C, 6E, 6G, 6H, 6J, 6N, 6P, 6V, 10, 14, 16, 1E, 1H.
Voluntary and Excluded Enrollment
SPDs will remain voluntary if they belong to one or more of the following groups:
Dual Eligibles, or those with Medicare
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