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Medi-Cal Update 2023-12 Managed Care Transition
January 2024 Medi-Cal Managed Care Transition
| Date | References | Clerical | Handbook(s) Revised |
| 12/4/2023 | MEDIL I 23-54, MEDIL I 21-30 | N/A | MC HB Chapter 11 |
Background
Through the California Advancing and Innovating Medi-Cal (CalAIM) initiatives, the California Department of Health Care Services (DHCS) is making changes to the Medi-Cal delivery system to ensure Californians have access to the care they need to live healthier lives. As part of these initiatives, beginning in 2024, Medi-Cal Managed Care Plans (MCPs) will be subject to new requirements intending to rigorously advance health equity, quality, access, accountability, and transparency to improve the Medi-Cal healthcare delivery system. As part of this transformation, some Medi-Cal MCPs are changing on January 1, 2024, based on how DHCS contracts with Medi-Cal MCPs.
Changes
Kaiser is currently available as a delegated subcontractor under the Santa Clara Family Health Plan in Santa Clara County. Beginning 1/1/2024 Kaiser will contract directly with DHCS and become a prime Managed Care Plan option. Medi-Cal members who are already enrolled in Kaiser can remain in Kaiser. For beneficiaries not currently enrolled in Kaiser, they may choose to enroll in Kaiser if they meet specific eligibility criteria which include:
- Are an existing Kaiser member transitioning into Medi-Cal managed care;
- Were previously enrolled with Kaiser, outside of Medi-Cal, during the 12 months preceding the effective date of their Medi-Cal eligibility;
- Have an immediate family member currently enrolled in Kaiser (i.e. a "family linkage"): Spouse/domestic partner; a beneficiary's dependent child, foster child, or stepchild under 26 years of age; a beneficiary's dependent who is disabled and over 21 years of age; a parent or stepparent of a beneficiary under 26 years of age; or a grandparent, guardian, foster parent, or other relative with appropriate documentation of a familial relationship of a beneficiary under 26 years of age as determined by the department.
- Are eligible for both Medi-Cal and Medicare; or
- Are a child or youth enrolled in the foster care system and identified with a foster care aid code.
Managed care enrollment in most cases is mandatory for individuals residing in Santa Clara County, receiving full-scope Medi-Cal coverage, and not required to pay a Share of Cost (SOC). There are some exceptions to this policy.
A new reference document: Aid Codes and Managed Care Enrollment has been created and posted to the intranet under Reference Materials and includes details on mandatory, voluntary, and exemptions from managed care enrollment.
All enrollment and disenrollment functions are handled by the Health Care Options (HCO) contractor. Medi-Cal recipients who need assistance with selecting, enrolling in, or disenrolling from a plan can contact HCO at 1-800-430-4263.
Implementation
These changes are effective 1/1/2024.
Forms
The Medi-Cal Managed Care Choice Enrollment Form has been updated with the option to choose Kaiser as a prime managed care plan.
Other Programs
This change only affects the Medi-Cal program.
Supervisors
Supervisors must review this Update and corresponding Handbook sections with your unit.
Angela Shing, Director
Department of Employment & Benefits Services
Contact Person(s): Megan Turney, SSA BPIS, 408-755-7540