Counties Start Moving Medi-Cal Beneficiaries to Managed Care

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On Wednesday, 16 California counties will start enrolling about 380,000 Medi-Cal beneficiaries who are elderly or have disabilities in managed care plans, the San Francisco Chronicle reports.

Medi-Cal is California's Medicaid program (Colliver, San Francisco Chronicle, 6/1).

Background

The move stems from the five-year, $10 billion Medi-Cal waiver the state secured from the federal government in November 2010 (California Healthline, 3/7). Funds from the waiver will go toward public hospitals and the expansion of local health programs (San Francisco Chronicle, 6/1).

Anthony Cava -- spokesperson for California's Department of Health Care Services -- said the new policy could reduce state spending by $365 million annually (Hines, Riverside Press-Enterprise, 5/29).

Details on Medi-Cal Shift

Previously, seniors and people with disabilities who had Medi-Cal coverage could choose whether to find their own physician or enroll in a managed care plan if one was available in their area.

Under the new policy, beneficiaries who live in counties that offer a managed care option will be required to sign up for that plan (San Francisco Chronicle, 6/1). The 16 counties that will be affected by the change are:

  • Alameda;
  • Contra Costa;
  • Fresno;
  • Kern;
  • Kings;
  • Los Angeles;
  • Madera;
  • Riverside;
  • Sacramento;
  • San Bernardino;
  • San Diego;
  • San Francisco;
  • San Joaquin;
  • Santa Clara;
  • Stanislaus; and
  • Tulare (Department of Health Care Services fact sheet, 6/1).

The shift to managed care will be phased in over the next year. Beneficiaries will need to select a plan by the month of their birthday, or the state will choose a plan for them.

Certain beneficiaries in the 16 counties will be exempt from the requirement, including:

  • Children in foster care;
  • Those who pay part of their Medi-Cal costs;
  • Those who receive coverage from both Medi-Cal and Medicare; and
  • Those who receive long-term care (San Francisco Chronicle, 6/1).

Broadcast Coverage

On Tuesday, KQED's "California Report" reported on Medi-Cal beneficiaries' shift to managed health care plans (Varney, "California Report," KQED, 5/31).


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