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.
January 1, 2023 Transition
Effective January 1, 2023, all MCPs are now responsible for the full LTC benefit at the following facility types and homes:
- Skilled Nursing Facility (SNF), both freestanding and hospital-based SNFs
The 31 counties where SNF coverage newly transitioned from Medi-Cal fee-for-service (FFS) to Medi-Cal managed care, and beneficiaries began enrolling 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.
Key information and updates on the SNF Carve-In can be found below.
January 1, 2024 Transition
Effective January 1, 2024, all MCPs will become responsible for the full LTC benefit at the following facility types and Homes:
- 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;
- Subacute Care Facility and;
- Pediatric Subacute Care Facility.
Note: ICF/DD-Continuous Nursing Care (ICF/DD-CN) Homes are not subject to the LTC Carve-In policy.
Important Updates
SNF and Subacute Care Facility LTC Carve-In Resources for Managed Care Plans – Updated January 2024
The SNF and Subacute Care Facility Resources for Managed Care Plans is intended to serve as a guide for MCPs to use for the transition to managed care. The updated document provides information on contracting requirements, promising practices, and suggested model contract language for the SNF and Subacute Care Facility LTC Carve-In. The Resources for Managed Care Plans document can be found under Key Documents.
Updated SNF Carve-In Frequently Asked Questions
DHCS has updated the SNF Carve-In Frequently Asked Questions document which addresses stakeholder inquiries on the SNF Carve-In implementation, benefits, care coordination, authorizations, facility payment, among other topics. The updated FAQ document can be found under Key Documents.
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 facilities 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 APL 23-004 SNFs – LTC Benefit Standardization and Transition of Members to Managed Care, FAQs, and the CalAIM SNF LTC Carve-In Resources for MCPs.
Key Documents
Long-Term Care (LTS) Skilled Nursing Facility (SNF) Membership Information:
DHCS will mail each Medi-Cal member in a Skilled Nursing Facility Enrollment Notices 60 days and 30 days before January 1, 2024. DHCS will also mail Member notices to authorized representatives documented within the Medi-Cal Eligibility Data System (MEDS).
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 hosted a SNF Carve-In education webinar series that concluded in February 2024. All materials from each webinar can be found below.
Past Webinars
Policy Update: Friday, February 24, 2023 at 2:00 pm.
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.
