​​​​​​​​CalAIM Long-Term Care Carve-In Transition  

Under CalAIM, Medi-Cal managed care plans (MCPs) will cover and coordinate Medi-Cal institutional Long-Term Care (LTC) in all counties in 2023 in a phased approach by facility type. This will provide all LTC residents with access to coordinated and integrated care within Medi-Cal managed care, and make 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. ​

Currently, the Medi-Cal LTC benefit for Skilled Nursing Facility (SNF) ser​vices is carved-in to Medi-Cal managed care in the following 22 County Organized Health System (COHS) and 7 Coordinated Care Initiative (CCI) counties: 

​Del Norte, Humboldt, Lake, Lassen, Los Angeles, Marin, Mendocino, Merced, Modoc, Monterey, Napa, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, San Mateo, Santa Barbara, Santa Clara, Santa Cruz, Shasta, Siskiyou, Solano, Sonoma, Trinity, Ventura, and Yolo.

All MCPs in COHS and CCI counties today cover institutional SNF in Medi-Cal managed care. However, the institutional LTC coverage by MCPs in the remaining 31 non-COHS and non-CCI counties is limited to the first month of admission and the following month. Subsequently, members are disenrolled from the MCP to Medi-Cal FFS after the second continuous month of admission in a SNF facility.​ 

Effective January 1, 2023, all MCPs will be responsible for the full LTC benefit at the following facility types and homes: ​

Medi-Cal beneficiaries residing in these facilities will begin receiving communications about these changes in November 2022.

The 31 counties where SNF coverage will be newly transitioning from Medi-Cal fee-for-service (FFS) to the Medi-Cal managed care, and beneficiaries will need to enroll in Medi-Cal managed care are: 

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. 

Effective July 1, 2023, all MCPs will become responsible for the full LTC benefit at the following facility types and homes:

DHCS has developed a Frequently Asked Questions (FAQ) document addressing stakeholder inquiries regarding CalAIM implementation, benefits, transition and care coordination, payment and rates, quality improvement, and policies and procedures. The FAQ was developed to help provide clarity to some stakeholder questions received during the CalAIM SNF LTC Carve-In educational webinar series. The FAQ may be found under Key Documents.

DHCS will be mailing two versions of the LTC SNF Enrollment Notices to members 60-days and 30-days prior to January 1, 2023 driven by member population type. The LTC SNF Enrollment Notices and Notice of Additional Information may be found under Key Documents. 

 

Members not part of the Medi-Cal matching plan policy will receive notices that include the name of the managed care plan the beneficiary will be enrolled in if they do not choose a managed care plan by the default date. DHCS will use an upfront provider linkage process that assigns a member to a MCP that works with their current LTC facility. If their LTC facility does not work with an MCP in their county, a default process will be used.

 

Members that are part of the Medi-Cal matching plan policy will receive notices that include the name of the managed care plan the beneficiary will be enrolled in based on their Medicare Advantage Plan enrollment. The State has a Medi-Cal matching plan policy in certain counties. This means that if the member joins a Medicare Advantage plan and there is a Medi-Cal plan that matches with that plan, they must choose that Medi-Cal plan. This policy does not change or affect their choice of a Medicare plan.

The 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 LTC carve-in transition in CCI counties, considered perspectives from Medi-Cal members, LTC facilities and homes, and MCPs, and prioritized the maximization of independence for members. 

The Workgroup convened seven times, from December 2021 through September 2022. Topics discussed at these meetings included the state of LTC services and coverage for Medi-Cal beneficiaries in 2022, MCP readiness, continuity of care, data sharing, facility communication and education needs, MCP oversight of LTC facilities, member communications, billing and payment, updates from the 2022 – 23 Governor’s Budget, and network readiness requirements. These meetings were key to informing policies, requirements, and promising practices for the SNF LTC Carve-In and resulted in the finalization of APL 22-018 SNFs – LTC Benefit Standardization and Transition of Members to Managed Care, FAQs, and the CalAIM SNF LTC Carve-In Resources for MCPs.​​

DHCS will be hosting a series of public educational webinars for the SNF LTC Carve-In transition to support Medi-Cal MCPs and the LTC provider network (specifically SNFs) as they prepare for this transition. The goal of these educational webinars is to inform stakeholders of the SNF LTC Carve-In policy requirements and how to best prepare to support and coordinate care for members. The webinars will occur monthly beginning in October 2022 through February 2023. SNF providers and Medi-Cal MCP representatives are encouraged to attend, and webinars will be open to the public. Details are provided in the Upcoming Webinars below.

To support stakeholder planning and implementation, DHCS is hosting educational webinars on SNF LTC Carve-In transition topics. Meeting materials will be made available here following each webinar. Advance registration is required.

Listed below are additional resources: