California’s Coordinated Care Initiative July 2014.

California’s Coordinated Care InitiativeJuly 2014

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Roadmap

• About the Coordinated Care Initiative• Cal MediConnect

• Medi-Cal Managed Long Term Services and Supports

• Timeline and Enrollment

• Participating in Cal MediConnect

• Additional Resources

The Coordinated Care Initiative: Where

San Bernardino

Riverside

San Diego

AlamedaSan Mateo

Santa Clara

Los Angeles

Orange*

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*Participation in Orange County pending readiness reviews.

Medicare

• Doctors

• Hospitals

• Prescription drugs

Medi-Cal

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Medicare and Medi-Cal Today

Who: 65+, under 65 with certain disabilities

Who: low-income Californians

• Long-term services and supports• MSSP: Multipurpose Senior

Services Program

• IHSS: In-Home Supportive Services

• CBAS: Community-Based Adult Services

• Nursing facilities

• Durable medical equipment

• Medicare cost sharing

Cal MediConnect

• Optional

• Combines Medicare and Medi-Cal benefits into one managed care health plan

• Additional services, including care coordination

Medi-Cal Managed Long-Term

Services and Supports (MLTSS)

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The Coordinated Care Initiative: Two Parts

• Mandatory

• Beneficiaries will now receive Medi-Cal benefits through a managed care health plan, including LTSS and Medicare wrap-around.

Who: many full dual eligible beneficiaries

Who: Medi-Cal only beneficiaries, full dual eligibles who opt out of

Cal MediConnect, other identified groups eligible for Medi-Cal

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Cal MediConnect

• Who: Medi-Medi beneficiaries

• Optional

• Original Medicare and Medi-Cal services

• One number for all your health care needs

• Vision benefit: one routine eye exam annually and a $100 co-pay for eye glasses/contacts every two years

• Transportation benefit: 30 1-way trips per year in addition to the existing transportation benefit

• Care Coordination

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• Cal MediConnect plans will give providers information and

resources to support care coordination.

• Health Risk Assessments (HRAs)

• Primary, acute, LTSS, behavioral health and functional needs

• Interdisciplinary Care Teams

• Beneficiary, plan care coordinator, key providers

• Individualized Care Plans

• Care teams will develop and implement ICPs

• Plan Care Coordinators

• Facilitates communication between plans, providers, beneficiary

Cal MediConnect Care Coordination

Care Coordination: Example

Patient X recently had a stroke and is back living at home.

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Before Cal MediConnect, the patient would have to navigate Medicare, Medi-Cal and county agencies to get needed social services – often relying on their doctor’s office staff for help.

Under Cal MediConnect, a plan care coordinator will ensure the patient has: • Transportation to

appointments• Coverage for prescriptions• Meals on Wheels • Other support for activities

of daily living

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You can combine your Medicare A, B & D with your Medi-Cal benefits into a Cal MediConnect plan

Select one of the

participating

Cal MediConnect

plans in your county

If you have Medicare and Medi-CalOption 1: Choose Cal MediConnect

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*Participation in Orange County pending readiness reviews.

Los Angeles• Care1st, CareMore, Health Net,

LA Care and Molina Health

Orange*• CalOptima

San Diego• Care 1st, Community Health

Group, Health Net and Molina Health

San Mateo• Health Plan of San Mateo

Alameda• Alameda Alliance and Anthem

Blue Cross

Santa Clara• Anthem Blue Cross and Santa

Clara Family Health Plan

San Bernardino• Inland Empire Health Plan and

Molina Health

Riverside• Inland Empire Health Plan and

Molina Health

Cal MediConnect Plan Options

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People not eligible for Cal MediConnect

You can’t join Cal MediConnect if you:

• Are younger than 21.

• Receive developmental disability waiver services from a Regional Center.

• Do not meet your Medi-Cal share of cost, if you have one.

• Have End-Stage Renal Disease (ESRD), except in San Mateo County.

• Have other health coverage, such as retirement, veterans or private coverage.

• Live in a veterans home.

• Receive services through one of the following waiver programs; Nursing Facility/Acute

Hospital, HIV/AIDS, Assisted Living, or In Home Operations (you must disenroll from these

programs to enroll in Cal MediConnect, you will not be passively enrolled).

• Are enrolled in PACE (you must disenroll to be eligible for the Cal MediConnect; will not be

passively enrolled).

• Live in some rural zip codes in Los Angeles, Riverside and San Bernardino Counties.

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Medi-Cal Managed Long-Term

Services and Supports

• Who: Medi-Cal only beneficiaries, full dual eligibles who opt out of Cal MediConnect, other identified groups eligible for Medi-Cal

• Mandatory

• Same Medi-Cal services

beneficiaries currently receive

• Hearing aids

• Bathrooms aids (grab bars, shower

chairs)

• Non-emergency medical transportation

(wheelchair vans and litter vans)

• Incontinence supplies

• Medi-Cal long-term services and

supports (MLTSS) will now be

coordinated by a managed care plan

• MSSP: Multipurpose Senior Services

Program

• IHSS: In-Home Supportive Services

• CBAS: Community-Based Adult Services

• Nursing facilities

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• Your Medicare including your Part D plan, will stay the same

• You will continue to use the same Medicare providers

• Your Medi-Cal benefits are now assigned to the Medi-Cal health plan

If you have Medicare and Medi-CalOption 2: Keep your Medicare as it is and join a Medi-

Cal health plan

Enroll in only a Medi-Cal Plan

Select one of the

participating

Medi-Cal plans in

your county

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If you have only Medi-CalYou must choose a Medi-Cal plan for your Medi-Cal

benefits

Enroll in a Medi-Cal Plan

Select one of the

participating

Medi-Cal plans in

your county

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*Participation in Orange County pending readiness reviews.

Los Angeles

• Health Net (Molina), LA Care (Anthem, Care 1st, Kaiser)

Orange*• CalOptima

San Diego• Care 1st, Community Health

Group, Health Net, Molina, and Kaiser

San Mateo• Health Plan of San Mateo

Alameda• Alameda Alliance and Anthem

Blue Cross

Santa Clara• Anthem Blue Cross and Santa

Clara Family Health Plan

San Bernardino• Inland Empire Health Plan

(Kaiser) and Molina (Health Net)

Riverside• Inland Empire Health Plan

(Kaiser) and Molina (Health Net)

MLTSS Plan Options

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PACE Program of All-inclusive

Care for the Elderly

• Who: Medi-Medi

beneficiaries and

Medi-Cal

beneficiaries

• Option available

to those who are

determined

eligible

If you:

• Are 55 or older

• Live in your home or community setting

safely

• Need a high level of care for a disability

or chronic condition

• Live in a ZIP code served by a PACE

health plan

You may be eligible to enroll in a PACE program

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PACE Plans

Los Angeles• Altamed Senior

BuenaCare and Brandman Centers for Senior Care

Orange*• CalOptima PACE

San Diego• St. Paul’s PACE

Alameda• Center for Elders’

Independence and On Lok Lifeways

Santa Clara• On Lok Lifeways

San Bernardino• InnovAge PACE

Riverside• InnovAge PACE

When to Expect Notices

• Beneficiaries will receive notices 90, 60, and

30 days prior to your coverage date.

• For most people their coverage date is the first day

of their birth month.

• Cal MediConnect official information from the state

will only arrive in blue envelopes.

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General Timeline

• April 2014 Enrollment in San Mateo

• May 2014 Enrollment in San Diego, Riverside, and

San Bernardino begins

• July 2014 Enrollment in Los Angeles begins*

• January 2015 Enrollment in Alameda, Santa Clara,

and Orange begins*

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*Enrollment in Orange County and select Los Angeles plans pending readiness reviews.

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Timeline Specifics

Individuals who receive passive enrollment notices:

• Already in Managed Medi-Cal – enroll/benefit added in 1 month

• Not in Managed Medi-Cal – enroll by birth month

• In CCI-health plan DSNPs – enroll in one month in January

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Timeline Specifics

Individuals who are eligible for Cal MediConnect but WILL NOT receive passive enrollment notices:

• Enrolled in non-CCI plan DSNP

• Enrolled in Medicare Advantage

• Enrolled in VA, waiver system, etc.

These populations will be asked to selected a Managed Medi-Cal (MLTSS) plan.

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Blue Envelope

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Cal MediConnect Notices

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90 Day Notice 60 Day Notice 30 Day Notice

MLTSS

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90 Day Notice 60 Day Notice 30 Day Notice

Choice Form

Section 3: Cal MediConnect Plan

To select a Cal MediConnect plan, complete section 3 ONLY.

Section 5: Medi-Cal PlanTo “Opt-Out” of Cal MediConnect, fill out section 5 ONLY. Choose the Medi-Cal plan you are already in or select the Medi-Cal plan you want to join.

Section 7: PACE PlansTo select a PACE plan complete section 7 AND also complete section 3 OR 5 as back-up options.

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Use the Choice Form to Choose the Plan you Want

• If you have both Medicare and Medi-Cal and you do nothing:

• You will be assigned to a Cal MediConnect plan that is the best match for you.

• If you have only Medi-cal and you do nothing:

• You will be assigned to a Medi-Cal plan that is the best match for you.

• This way you will not lose your Medicare or Medi-Cal benefits or services.

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Enrollment: Health Care Options

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Call Health Care Options to:

• Enroll in a Cal MediConnect plan, or

• Enroll in a Medi-Cal plan (and keep your

Medicare as it is today), or

• Enroll in a PACE plan

1-844-580-7272

Enrollment

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• The use of independent agents/brokers will not

be permitted and all MMP enrollment

transactions must be processed by the State

enrollment broker (Health Care Options).

• If an individual is cross walked into a Cal

MediConnect plan in some cases the broker may

still receive payment from the health plan.

www.calduals.org

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Additional Resources

• Health Insurance Counseling and Advocacy Program (HICAP)• Call HICAP for free unbiased counseling

• Email [email protected]

• Twitter @CalDuals

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