The Healthy Families Program Transition into Medi-Cal

1. Overview and Children’s Advocates’ Response The Healthy Families Program Transition into Medi-Cal Kristen Golden Testa Director, CA Health Program The Children’s Partnership LA Collaborative October 31, 2012 www.childrenspartnership.org

2. Budget Decision The Governor’s 2012/12 budget to eliminate Healthy Families Program (HFP) and transfer all HFP enrollees to Medi-Cal Legislature adopted with oversight requirements and allowed for a flexible start date, no sooner than January 1, 2013.

3. Transition Basics • All HFP children transfer to Medi-Cal • Children above 150% FPL income charged premiums • Transition in 2013 over phases based on county health plans comparability to HFP

4. Phases of the Transition • Phase 1 (DHCS timeline: January and March 2013) • Part A counties (208,376 kids): Alameda, Riverside, San Bernardino, San Francisco , Santa Clara, Orange , San Mateo, San Diego • Part B counties (185,714 kids) : Contra Costa, Fresno, Kern, Kings, Los Angeles, Madera, Tulare, Sacramento, Napa, Solano, Sonoma, Yolo, Monterey, Santa Cruz, Santa Barbara, San Luis Obispo • Phase 2 (261,060 kids; After April 1, 2013) • Phase 3 (152,602 kids; After August 1, 2013) • Phase 4 (42,753 kids; After September 1, 2013)

5. Implementation Process • Flexible transition start dates (but DHCS committed to January start date) • Legislative oversight: • Strategic plan; • Implementation plans for each phase; • Network Adequacy Assessment • Stakeholder engagement • Notices to Families • Federal CMS approval

6. Transition Issues: Enrollment • Sufficient notice to families about the transfer with “first responders” (counties, CAAs, doctors, teachers, etc) ready to respond • Transitioning children transferred without gaps or having to provide additional information • Not charged premiums if MC income level is below 150% • New applicants should all receive AE

7. What Families Should Expect General notice 60- and 30-day notices for Phase 1 90-, 60-, and 30-day notices for Phases 2-4 Medi-Cal welcome packet Benefit Identification Card (BIC) Packet from managed care plan (and dental managed care plan, where relevant)

8. Transition Issue: Realistic Timeline • Flexible transition start date • Implementation plan needed • Sequence essential steps. Prior to sending notices: • Federal approval • Eligibility policies finalized • Network adequacy assessment reviewed • Outreach and information to “first responders”

9. Transition Issue: Access • Health plan network adequacy assessment: public review and contingency plans • Direct provider participation survey • Ongoing monitoring

10. Transition Issue: Federal Approval 1115 Waiver for transition Network Adequacy approval Eligibility and enrollment approval Premium approval

11. Transition Issue: Performance • HFP Transition performance standards: • Did children transfer without gaps • Were they able to continue care • How did their access compare • Baseline comparison to transition

12. Taking Action • To CHHS: • Not ready for January 1, more reasonable timeline • Performance measures needed • Plans for improving access and continuity of care • Local feedback on readiness and needs on the ground • To Legislature: • Ensure transition readiness and children can see their doctor/dentist before transition begins.

13. Key Upcoming Dates • November 1: Network adequacy assessment released and 60-day notice to families • Upcoming Stakeholder Webinars: • December 7, 1-3pm • Federal waiver submission and approval?

14. Key Websites on the Transition MRMIB http://www.mrmib.ca.gov/MRMIB/HFPTransition.html DHCS http://www.dhcs.ca.gov/services/Pages/HealthyFamiliesTransition.aspx

15. For More Information TCP’s Website: www.childrenspartnership.org Contact me: Kristen Golden Testa 415-505-1332 ktesta@childrenspartnership.org