Presentation to Family Voices of California on Healthy Families Program Transition to Medi-Cal August 21, 2013
Agenda Overview of the Healthy Families Transition Brief Comparison of Benefits Between HFP & Medi-Cal Overview of the Completed Transition Efforts Overview of Phases 4A and 4B Transition Efforts What Professionals and Providers Should Know Contact Information Q & A 2
Overview of Transition Children in HFP ages 0 through 18 with incomes up to and including 250 percent of the Federal Poverty level (FPL) New optional Targeted Low Income Children s (TLIC) Program covers new enrollees of ages 0 through 18 with income up to and including 250 percent FPL Goals of Transition Collaboration and Coordination Monitoring Reports Mental Health Screening 3
Brief Comparison of Benefits ELIGIBILITY Healthy Families Medi-Cal Age Limit of a Child Up to age 19 1 Up to age 21 HEALTH BENEFITS Healthy Families Medi-Cal Acupuncture 20 visits/benefit year 2 2 visits/month Biofeedback Covered 3 Covered Blood and Blood Products Covered Covered California Children s Services (CCS) Program Services Covered Covered Cataract Spectacles and Lenses, Cataract Contact Lenses Covered Covered Chiropractic Services 20 visits/benefit year 4 2 visits/month Clinical Cancer Trials Covered Covered Diabetic Care Covered Covered Diagnostic, X-Ray and Laboratory Services Covered Covered Durable Medical Equipment Covered Covered Emergency Health Care Services Covered Covered 1 Currently under the HFP, once a child turns19, s/he is referred to Medi-Cal for a determination under the Medically Needy program which may include being assessed for share-of-cost Medi-Cal. 2 Not all health plans provide this option. 3 Not all health plans provide this option. 4 Not all health plans provide this option. 4
Completed Transition Efforts Population Total Number of Children Transitioned Phases 1A, 1B, and 1C - Total transitioned: 385,601 Phase 2 - Total transitioned: 228,152 Phase 3 - Total transitioned: 104,915 Enrollments Jan 2013 Feb 2013 Mar 2013 May 2013 Jun 2013 12,737 21,660 11,941 83,719 23,535 19,207 Disenrollments Jan 2013 Feb 2013 Mar 2013 May 2013 Jun 2013 0 124 14,964 11,192 37,697 20,837 5
Completed Transition Efforts Access to Health Care Percentage of Children Assigned a Primary Care Physician Jan 2013 (Phase 1A) Mar 2013 (Phase 1B) (Phase 2) May 2013 100% 93.88% 95.44% 98.14% 99.72% Percentage of Children Changing their Primary Care Physicians Jan 2013 (Phase 1A) Mar 2013 (Phase 1B) (Phase 2) May 2013 1.04% 6.07% 14.81% 20.67% 27% 6
Completed Transition Efforts Access to Health Care (cont.) Percentage of Children Maintaining their Health Plans Jan 2013 (Phase 1A) Mar 2013 (Phase 1B) (Phase 2) May 2013 99.86% 100% 99.24% 99.48% 99.73% Percentage of Children Changing their Health Plans Jan 2013 (Phase 1A) Mar 2013 (Phase 1B) (Phase 2) May 2013 0.13% 0% 0.07% 0.05% 0.04% Percentage of Children Changing to FFS Jan 2013 (Phase 1A) Mar 2013 (Phase 1B) (Phase 2) May 2013 0.01% 0% 0.69% 0.47% 0.23% 7
Completed Transition Efforts Access to Dental Care Percentage of Warm Transfer w/ Successful Referrals (CoC) Jan 2013 Feb 2013 Mar 2013 May 2013 Jun 2013 100% 100% 100% 100% 100% 100% Percentage of successful referrals resulting in scheduled appointments (CoC) Jan 2013 Feb 2013 Mar 2013 May 2013 Jun 2013 93% 99% 98% 92% 87% 85.7% 8
Completed Transition Efforts Access to Dental Care (cont.) Number of Newly Enrolled FFS & Dental Providers Jan 2013 Feb 2013 Mar 2013 May 2013 Jun 2013 276 288 221 142 185 175 Number of Disenrolled Dental Providers Jan 2013 Feb 2013 Mar 2013 May 2013 Jun 2013 71 88 73 85 57 93 9
Completed Transition Efforts Access to Mental Health Care Number of Transitioned Children Receiving Services Jan 2013 Feb 2013 Mar 2013 May 2013 Jun 2013 912 1,028 1,187 1,074 483 Data Not Yet Available Number of OTLIP Children Receiving Services Jan 2013 Feb 2013 Mar 2013 May 2013 Jun 2013 313 785 989 872 357 Data Not Yet Available 10
Completed Transition Efforts Access to Substance Use Disorder Services Number of Children Receiving Services Jan 2013 Feb 2013 Mar 2013 May 2013 Jun 2013 19 51 87 164 Data Not Yet Available Data Not Yet Available 11
Phases 4A and 4B Transition Phase 4A No sooner than September 1, 2013 Approximately 7,200 Children to Transition Phase 4B No sooner than November 1, 2013 Approximately 25,000 Children to Transition 12
What Professionals & Providers Should Know For Phase 4A & Phase 4B: Provider to Member Ratio Physician Extenders Health Plan Reassessments Provider Network Capacity 13
Contact Information DHCS Transition Webpage http://www.dhcs.ca.gov/services/pages/healthyfamiliestransition.aspx DHCS Email Box for Information/Questions DHCSHealthyFamiliesTransition@dhcs.ca.gov MRMIB Transition Webpage http://mrmib.ca.gov/mrmib/hfptransition.html MRMIB Email Box for Information/Questions hfptransition@mrmib.ca.gov 14
Questions and Answers 15