California’s Coordinated Care Initiative

July 2014

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 2

The Coordinated Care Initiative: Where

San Mateo Santa Clara Los Angeles Orange* *Participation in Orange County pending readiness reviews. 3 Alameda San Bernardino Riverside San Diego

Medicare and Medi-Cal Today Medicare

Who: 65+, under 65 with certain disabilities • Doctors • Hospitals • Prescription drugs 4

Medi-Cal

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

The Coordinated Care Initiative: Two Parts Cal MediConnect Medi-Cal

Managed Long-Term Services and Supports (MLTSS) Who: many full dual eligible beneficiaries • Optional • Combines Medicare and Medi-Cal benefits into one managed care health plan • Additional services, including care coordination • • Who: Medi-Cal only beneficiaries, full dual eligibles who opt out of Cal MediConnect, other identified groups eligible for Medi-Cal Mandatory Beneficiaries will now receive Medi-Cal benefits through a managed care health plan, including LTSS and Medicare wrap-around.

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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 6

Cal MediConnect Care Coordination

• 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 7

Care Coordination: Example

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

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.

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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

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

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 9

Cal MediConnect Plan Options

Los Angeles • Care1st, CareMore, Health Net, LA Care and Molina Health Alameda • Alameda Alliance and Anthem Blue Cross Orange* Santa Clara • CalOptima • Anthem Blue Cross and Santa Clara Family Health Plan San Diego San Bernardino • Care 1 Health st , Community Health Group, Health Net and Molina • Inland Empire Health Plan and Molina Health San Mateo Riverside • Health Plan of San Mateo • Inland Empire Health Plan and Molina Health *Participation in Orange County pending readiness reviews. 10

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 12

If you have Medicare and Medi-Cal

Option 2: Keep your Medicare as it is and join a Medi-Cal health plan • 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

Enroll in only a Medi-Cal Plan

Select one of the participating Medi-Cal plans in your county 13

If you have only Medi-Cal

You 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 14

MLTSS Plan Options

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

Kaiser

) Orange* • CalOptima San Diego • Care 1

Kaiser

st , Community Health Group, Health Net, Molina, and San Mateo • Health Plan of San Mateo *Participation in Orange County pending readiness reviews. 15 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

)

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

You may be eligible to enroll in a PACE program

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 16

Los Angeles • Altamed Senior BuenaCare and Brandman Centers for Senior Care Orange* • CalOptima PACE San Diego • St. Paul’s PACE

PACE Plans

17 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* *Enrollment in Orange County and select Los Angeles plans pending readiness reviews. 19

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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 21

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. 22

Blue Envelope

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Cal MediConnect Notices

90 Day Notice 60 Day Notice 30 Day Notice 24

90 Day Notice

MLTSS

60 Day Notice 30 Day Notice 25

Choice Form

Section 3: Cal MediConnect Plan

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

Section 5: Medi-Cal Plan

To “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 Plans

To 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. 27

Enrollment: Health Care Options

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

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Enrollment

• 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. 29

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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