Monday, May 23, 2011

Mandatory MediCal HMO Enrollment in 16 California Counties

On June 1, 2011, the following California counties will begin a 12-month process of welcoming newly enrolled beneficiaries into their managed care plans: Alameda, Contra Costa, Fresno, Kern, Kings, Los Angeles, Madera, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, Santa Clara, Stanislaus, and Tulare.

This reassignment is part of a “bridge” from Fee-For-Service (FFS) Medi-Cal to the complete implementation of the Affordable Care Act by year 2014.

As of now, Fee-for-Service MediCal recipients are receiving letters directing them to enroll in a Medi-Cal Managed Care Plan by the end of their birthday month. The letter also states that if a plan is not chosen by the deadline, one will be randomly assigned.

Mandatory enrollment does not apply to Medi-Cal/Medicare (Medi-Medi or “dual eligibles”) recipients or to:

• Those who are Foster Children
• Those identified as Long Term Care (LTC)
• Those who have Other Health Insurance
• Those who have Share of Cost (SOC) Medi-Cal
• Those who are California Children's Services (CCS) recipients (Although currently excluded, this group may become mandatory in the future)


This change does apply to those with Medi-Cal only and no Share-of-Cost. MediCal Aid Codes affected by the change are: 20, 24, 26, 2E, 2H, 36, 60 (SSI-linked Medi-Cal), 64, 66, 6A, 6C, 6E, 6G, 6H, 6J, 6N, 6P, 6V, 10,14, 16, 1E, 1H.

For those with special needs Medical Exemption Request can be submitted. This may allow those requiring continued standard Fee-for-Service Medi-Cal to remain in effect The form can be found at:
http://www.healthcareoptions.dhcs.ca.gov/HCOCSP/Enrollment/content/en/forms/MU_0003383.pdf

The plans available in Los Angeles County are:
Positive Healthcare (800) 263-0067
AltaMed (PACE) (323) 728-0411
Health Net Community Solutions, Inc. (800) 675-6110
L. A. Care Health Plan (888) 839-9909
SCAN Health Plan (877) 452-5898

For information about the plans and to find comparison charts go to http://www.healthcareoptions.dhcs.ca.gov for more information or call Michael Van Essen, Director of Benefits Establishment, 626-254-5043.

3 comments:

James said...

What is a good individual health insurance plan? This is a frequently asked question for most people. I will say a plan that has reasonable rate in terms of the health benefits it provides and that gives all you need.

James said...

This gives me more information about all these famous California health insurance carriers. I think Obama health reform does make these carriers acceralte improving their company system. This can benefit people in long run.

angela argyle said...

Thank you so much for the link to the exemption form. I've had an impossible time finding information on how to stay out of this HMO business for my disabled SO.