Beau Hennemann IHSS Program Manager Consumer, Family and Caregiver Forum February 1, 2013
L.A. Care is the nation s largest public health plan, with more than 1 million members. L.A. Care is governed by a 13 member board, which is made up of individuals from the community and includes Medi-Cal consumers. Our Vision: A healthy community in which all have access to the health care they need. 2
Key terms What is the CCI? What is a Health Plan? Who will this affect? How will LTSS work in a Health Plan? When will this take place? 3
Medi-Cal: State program that pays for a variety of medical services for children and adults with limited income and resources. Medicare: Federal program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (kidney failure) LTSS: Long-Term Services and Supports Consumer: Any one who receives Medi-Cal or both Medi-Cal and Medicare 4
Dual Eligible HMOs Health Insurance Company Duals Managed Care Medi Medi Medi-Medi refers to people who are have both Medicare and Medi-Cal. Health Plan Health Plans are organizations responsible for coordinating and delivering healthcare services. 5
Approved by the state legislature in June 2012 Has three key parts 1. Transition of Medi-Cal LTSS to Health Plans 2. Mandatory enrollment into Health Plans for Medi-Cal benefits 3. Transition of Medi-Medi consumers into Health Plans for the coordination all of their Medicare and Medi-Cal services 6
To develop a system that coordinates all benefits and healthcare under one Health Plan To help consumers: Live healthier at home for as long as possible Get the right services and supports 7
In eight counties: Los Angeles Orange San Diego San Mateo San Bernardino Riverside Alameda Santa Clara Del Norte Trinity Humboldt Siskiyou Mendocino Glenn Butte Sierra Nevada ColusaSut- ter Yuba Placer Lake Yolo El Dorado Sonoma* Napa Sacramento Alpine Amador Solano CalaverasTuolumne Costa* Joaquin** Marin Contra San San FranciscoAlameda* Stanislaus Mariposa San Mateo Santa Clara Merced Santa Cruz Shasta Tehama Modoc San Benito Monterey Lassen Plumas Madera** San Luis Obispo Fresno Kings** Mono Tulare Kern Santa Barbara Ventura* Imperial 8
What is a Health Plan? A Health Plan is an organization that pays for and arranges all of your care including: Medical care (doctor and specialist visits, lab work, X-rays, hospital stays, emergency care) Prescription medications Behavioral health services Medical equipment and supplies LTSS Non-emergency transportation 9
You have one main doctor called a primary care physician who helps you get the healthcare you need Your healthcare and support services are coordinated by your Health Plan Your Health Plan helps fix problems You do not lose your Medi-Cal or Medicare There is no additional cost 10
Free nurse advice line 24 hours a day Member Services staff to help you with questions about benefits, providers and services Health education classes Help with management of diabetes, asthma, and other health issues 11
Most Medi-Cal consumers will have to join a Health Plan for their medical care and other benefits like: LTSS (IHSS, CBAS, MSSP, LTC) Non-emergency transportation (medically necessary) Incontinence supplies Medical equipment 12
Medi Cal Only Consumers Health Plan Services doctors, hospital, pharmacy, equipment, LTSS, transportation, incontinence supplies, etc. 13
Medi-Medis can join a plan and get ALL their healthcare and support services from one Health Plan (all Medicare and Medi-Cal benefits, combined). Medi-Medis can OPT-OUT of joining a plan for their medical coverage, but will have to remain enrolled to receive benefits like: LTSS Non-emergency transportation (medically necessary) Incontinence supplies Some medical equipment that Medicare doesn t cover 14
Medi Medis who Join a Plan Health Plan Services doctors, hospital, pharmacy, equipment, behavioral health, LTSS, transportation, incontinence supplies, etc. 15
Medi Medis who Opt Out Medicare Services doctors, hospital, pharmacy, equipment, behavioral health Health Plan Services LTSS, trans., incontinence supplies, etc. 16
Some consumers may be excluded from joining a Health Plan for their Medicare services, while others may be excluded from the entire Coordinated Care Initiative. For more information on who might be excluded, please see the Draft HCBS Enrollment Flow Charts posted on the Department of Health Care Services website at www.calduals.org. 17
Health Plans will soon cover: IHSS (In-Home Supportive Services) MSSP (Multipurpose Senior Services Program) CBAS (Community Based Adult Services) Nursing home care 18
IHSS provides in-home care to seniors and persons with disabilities allowing them to remain safely in their home. Services offered include domestic services, personal care, paramedical services, and others. What is Changing? You will have to enroll in a Health Plan to continue receiving IHSS services. Health Plans will be financially responsible for IHSS. What Stays the Same? You will maintain your rights to hire, fire, train, and supervise your own homecare worker. County agencies administering the IHSS program will maintain their current roles. Health Plans will not be able to reduce IHSS hours. 19
MSSP is an intensive case management program that provides both social and health care management for older adults who wish to remain in the community. What is Changing? You will have to join a Health Plan to continue receiving MSSP services. What Stays the Same? You will continue to get the same services through your MSSP. 20
CBAS, formerly known as Adult Day Health Care, is a facility-based service program that delivers skilled nursing, social services, physical and occupational therapies, personal care, training and support for families and caregivers, nutrition services and transportation. What is Changing? As of December 1, 2012, you must be enrolled in a Health Plan to receive CBAS services. What Stays the Same? CBAS centers still determine levels of service. 21
LTC is the provision of medical, social, and personal care services in a skilled nursing facility (SNF) or nursing home. What is Changing? Health Plans will pay for SNF care and will help coordinate healthcare services for you while you reside in a SNF. What Stays the Same? You can stay in the SNF you currently reside in. You will have to join a Health Plan to receive SNF care through Medi-Cal. 22
Enrollment in L.A. County will begin September 1, 2013, and will last for 18 months (subject to change!). Informational mailings from the State will start going out in June 2013 (subject to change!). If you don t choose a Health Plan to join, you will be automatically enrolled in a plan by the State. You can change Health Plans on a monthly basis. 23
In L.A. County you will be able to choose between two plans: L.A. Care Health Plan Health Net Additional information on enrollment will be provided in notices mailed to you by the State. 24
All Medi-Cal consumers will have to join a Health Plan beginning as early as September 2013. Medi-Medis can join a plan that coordinates all their Medi-Cal and Medicare benefits. Health Plans will be responsible for the provision of IHSS, CBAS, MSSP, and LTC/SNF. 25
www.calduals.org State Dept. of Health Care Services site that has stakeholder meetings and important documents on the CCI and the duals pilot. www.lacare.org/duals L.A. Care site with updated information and links to events and documents related to the CCI and the duals pilot. 26