CalAIM Skilled Nursing Facility Long-Term Care Carve-In
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California is transforming Medi-Cal through several initiatives to continue to drive quality of care improvements, streamline and reduce complexity, and build upon equity-focused, data-driven, and whole-person care. The Skilled Nursing Facility (SNF) Carve-In to Medi-Cal managed care standardizes SNF services covered under managed care statewide in order to advance a more consistent and integrated system of managed care and increase access to comprehensive care coordination, care management, and a broad array of services for Medi-Cal members in SNFs.
What the Carve-In means for Californians
On January 1, 2023, all managed care plans (MCPs) became responsible for covering the long-term care (LTC) services provided in SNFs, including both freestanding and hospital-based SNFs.
MCPs coordinate the care members require both within SNFs as well as from other providers. MCPs provide members with a network of health care providers and care coordination services to help manage member care.
More information for members can be found on the LTC Carve-In Member Information webpage.
Key Carve-In Documents
Policy Guidance
- All Plan Letter 24-009 SNF-LTC Benefit Standardization and Transition of Members to Managed Care (Updated September 16, 2024)
- SNF Carve-In Frequently Asked Questions (Updated October 25, 2024)
- MCP LTC QAPI Letter
Additional Carve-In Resources
- SNF LTC Carve-In Member Fact Sheet
- SNF and Subacute Care Facility Carve-In: Resources for Managed Care Plans
Managed Care Resources for LTC Providers
- Medi-Cal Authorizations LTC Resource
- Medi-Cal Billing and Payment LTC Resource
- Medi-Cal Eligibility and MCP Enrollment LTC
Resource
Informational Webinars
Department of Health Care Services (DHCS) hosted educational webinars to support stakeholders with the Carve-In implementation. Details and materials for the webinars can be found at the following link:
Additional Resources
- CalAIM Managed Long Term Services and Supports & Duals Stakeholder Integration Workgroup
- California Long-Term Services and Supports Dashboard
- Transitional Care Services for Members with Long-Term Services and Supports Needs
- Automated Eligibility Verification System (AEVS) via the DHCS Provider Portal – where providers can find MCP enrollment information for members
Questions
Contact DHCS with any questions about the SNF LTC Carve-In at LTCTransition@dhcs.ca.gov.