Under CalAIM, Medi-Cal managed care plans (MCPs) began covering and coordinating Medi-Cal institutional Long-Term Care (LTC) in all counties starting in 2023 in a phased approach by benefit type. The transition to managed care provides all LTC residents with access to coordinated and integrated care within Medi-Cal managed care, and makes coverage consistent across California. The goal of the Medi-Cal LTC Carve-In is to better integrate care across institutional and home- and community-based settings as well as to make the LTC delivery system consistent across all counties in California. MCPs can offer complete care management, and provide a broader array of services, including Enhanced Care Management and Community Supports.
January 1, 2023 Transition
Effective January 1, 2023, all MCPs became responsible for covering the following LTC benefit:
The 31 counties where SNF coverage newly transitioned from Medi-Cal fee-for-service (FFS) to Medi-Cal managed care:
Alameda, Alpine, Amador, Butte, Calaveras, Colusa, Contra Costa, El Dorado, Fresno, Glenn, Imperial, Inyo, Kern, Kings, Madera, Mariposa, Mono, Nevada, Placer, Plumas, Sacramento, San Benito, San Francisco, San Joaquin, Sierra, Stanislaus, Sutter, Tehama, Tulare, Tuolumne, and Yuba.
DHCS has developed policies and resources to support the transition of SNF coverage from FFS Medi-Cal to Medi-Cal managed care. All resources can be found under “Key Documents” section. As new or updated resources are published, they will be highlighted in the “Important Updates” section.
January 1, 2024 Transition
Effective January 1, 2024, all MCPs became responsible for covering the following LTC benefits:
- Intermediate Care Facility for Developmentally Disabled (ICF/DD) Home;
- Intermediate Care Facility for the Developmentally Disabled – Habilitative (ICF/DD-H) Home;
- Intermediate Care Facility for the Developmentally Disabled – Nursing (ICF/DD-N) Home;
- Adult Subacute Care and;
- Pediatric Subacute Care
Note: ICF/DD-Continuous Nursing Care (ICF/DD-CN) Homes are not subject to the LTC Carve-In policy.
Key information and updates on the Intermediate Care Facility for the Developmentally Disabled (ICF/DD) LTC Carve-In.
Key information and updates on the
Subacute Care LTC Carve-In.
Important Updates
Quality Assurance and Performance Improvement (QAPI) Program Requirements
In January 2025, DHCS released a letter to Skilled Nursing Facilities (SNFs) providing requirements for the development and implementation of QAPI programs specific to long-term care provided in SNFs. The letter provides clarification on the MCP quality monitoring requirements established in APL 24-009, directing MCPs to develop a QAPI program to improve the quality of care provided by contracted SNFs. The letter regarding QAPI program requirements can be found under Key Documents.
All Plan Letter and Frequently Asked Questions – Updated September/October 2024
In September 2024, DHCS released 24-009: SNF – LTC Benefit Standardization and Transition of Members to Managed Care, which supersedes APL 23-004. The revised APL clarifies requirements for authorization timelines, Share of Cost, and processes for implementing updated Medi-Cal FFS per diem rates. In October 2024, DHCS issued an updated SNF Frequently Asked Questions (FAQs) document to further clarify updates made in the revised APL. The revised APL 24-009 and FAQs can be found under Key Documents.
LTC Learning Series
DHCS is hosting an LTC Learning Series during Fall 2024. The LTC Learning Series consists of a series of educational webinars for Medi-Cal MCPs and all LTC providers. The content presented in these webinars has been shaped by stakeholder feedback with the goal of enhancing MCPs', LTC providers', and interested stakeholders' understanding of Medi-Cal managed care and LTC. Each session covers different topics tailored to its intended audience. Details are included under Informational Webinars below.
SNF LTC Carve-In Workgroup
The SNF LTC Carve-In Workgroup was established in December 2021 to provide an opportunity for key stakeholders to collaborate and help inform DHCS’ policy and operational efforts for the LTC Carve-In. Workgroup participants included Medi-Cal MCP representatives, advocates, providers, and associations. The Workgroup leveraged the expertise of members from the SNF LTC Carve-In transition in CCI counties, considered perspectives from Medi-Cal members, LTC providers and homes, and MCPs, and prioritized the maximization of independence for members.
The Workgroup convened seven times, from December 2021 through September 2022. These meetings were key to informing policies, requirements, and promising practices for the SNF LTC Carve-In and resulted in the finalization of the SNF Carve-In APL..
Key Documents
Long-Term Care (LTS) Skilled Nursing Facility (SNF) Membership Information:
DHCS developed member notices and other resources designed to ensure a seamless transition for members whose SNF coverage transitioned from FFS Medi-Cal to Medi-Cal Managed Care.
These notices differ depending on the county the member lives in and whether the member is a part of Medi-Cal matching plan policy.
- Members in Skilled Nursing Facilities in Geographic Managed Care (GMC), Two-Plan, or Regional counties that are part of the Medi-Cal matching plan policy will receive notices with the Managed Care Plan that they must join based on their Medicare Advantage plan. These members will automatically be enrolled in the Managed Care Plan that matches their Medicare Advantage plan.
- Members in Skilled Nursing Facilities in Geographic Managed Care (GMC), Two-Plan, or Regional counties, but not part of the Medi-Cal matching plan policy will receive notices that include the Medi-Cal Managed Care Plan they will be enrolled in if they do not choose one by the selection deadline. These members will also receive a separate My Medi-Cal Choice packet to choose a Medi-Cal Managed Care Plan in November.
- Members in Skilled Nursing Facilities in COHS and Single Plan expansion counties, but not part of the Medi-Cal matching plan policy will receive notices with the Managed Care Plan they will automatically be enrolled in.
LTC Skilled Nursing Facility Notice of Additional Information (NOAI)
The Skilled Nursing Facility LTC Notice of Additional Information (NOAI) is also below. The NOAI has more information about the change to Medi-Cal Managed Care and what it means for Medi-Cal members receiving Skilled Nursing Facility services.
Informational Webinars
To support stakeholder planning and implementation, DHCS is hosting an educational webinar series. Details and materials for each webinar can be found below.
Upcoming Webinars
Past Webinars
LTC Learning Series: Managed Care Resources for LTC Providers: December 17, 2024 at 9:00 a.m.
Long-Term Care (LTC) Learning Series: LTC Policy Update: Monday, November 4, 2024 at 11:00 a.m.
Policy Update: Friday, February 24, 2023 at 2:00 p.m.
How Medi-Cal Managed Care Supports SNF Residents Webinar: Monday, January 30, 2023 at 2:00 p.m.
SNF LTC Billing and Payment Rules: Friday, December 2, 2022, at 1:00 p.m.
Promising Practices for SNF and MCP Contracting: Friday, November 4, 2022, at 1:00 p.m.
SNF LTC Carve-In 101 for SNFs: October 7, 2022, at 1:00 p.m.
SNF LTC Carve-In 101 for MCPs: September 21, 2022 at 10:00 a.m.
