HCO Referrals

Individuals who complete a face-to-face interview and are required to enroll in a managed care plan can be referred to an HCO representative for a consultation providing information on managed care health plans/providers and assistance in completing the enrollment choice form.

The completed Enrollment Choice form can be held by HCO staff for up to 120 days prior to the approval of benefits if the client chooses to meet with a representative and pick a plan ahead of the MC being approved.

HCO Referral Form

The “Health Care Options Referral Form” (SCD 31) is used to refer clients who are completing a face-to-face interview at BAC, North County and South County district offices to HCO staff for a consultation. This includes both mandatory and voluntary recipients.

Enrollment Information Packet

MC recipients also have the option to enroll by mail and phone. Individuals who are required to enroll in one of the MC MCPs are mailed a packet of information that includes:

An enrollment form with written notice of the requirement to select one of the available MCPs
The number to call for enrolling by phone
Information about requesting an exemption from the mandatory enrollment requirement under certain conditions.
A list of healthcare providers affiliated with each managed care network

This information will help recipients determine whether a doctor or clinic is affiliated with one of the plans.

Choosing a Primary Care Provider (PCP)

MC recipients must select a Primary Care Provider (PCP) in addition to selecting a plan. If the individual does not make a selection within a specified time, the plan will assign a PCP.

HCP Information on MEDS

Both the Santa Clara Family Health Plan, Blue Cross of California, and Kaiser plans are reflected in the [HCP-NO] field on various MEDS screens with a three-digit numeric code as follows:

Managed Care Plan Code for Santa Clara Family Health Plan: 309
Managed Care Plan Code for Blue Cross of California: 345
Managed Care Plan Code for Kaiser Foundation Health Plan: 374

A two-digit numeric or alpha/numeric code in the [HCP-STAT] identifies a recipient’s enrollment status in the associated managed care plan.

Cost of Care in Managed Care Plans

Covered benefits are provided at no charge to the recipient when enrolled in one of the managed care plans.

Transportation Services for Managed Care Recipients

Transportation services are available to Managed Care recipients through each of the following managed care plans.

Recipients can request transportation services via the process below:

Santa Clara Family Health Plan: Contact customer service at 1-800-260-2055 at least 7 days before the appointment. The appointment must be for services covered through the health plan, and the doctor must be a SCFHP provider. When requesting transportation, clients should be prepared to provide the date and time of the appointment, address of the appointment, pick up location, member ID number, and name of the doctor they are seeing.
Anthem Blue Cross of California: Request transportation services through the doctor prior to the appointment. Contact transportation reservations at 1-877-931-4755 (TTY 711) at least 7 days before the appointment. When requesting transportation, clients should be prepared to provide the date and time of the appointment, address of the appointment, pick-up location, member ID number, and name of the doctor they are seeing.

MCP and HCO Contact Information Updates

MCPs and HCOs provide the County with a list of clients who have reported a change in their contact information. This listing is distributed to District Offices for processing. The HCO or MCP is responsible for obtaining the client’s consent to share their information and then informing the County that it has the client’s consent. This effort will provide the opportunity to maintain the most up-to-date contact information for clients.