6% Need New Providers in Transition From Healthy Families to Managed Medi-Cal

About three-quarters of the way through the transition of 768,000 California children from the Healthy Families program to Medi-Cal managed care plans, a little more than 6% have needed to switch providers and an even smaller number have had to change health plans.

That relatively low level of disruption reflects the effort and care the state has shown in implementing this transition, according to Rene Mollow, deputy director of benefits and eligibility at the Department of Health Care Services, which is overseeing the transition.

“I believe, unequivocally, that the department has been successful in this transition,” Mollow said. “We’ve been able to transition a large number of children, and those kids have been able to access services with a minimum of disruption.”

So far, roughly 614,000 children have been shifted to Medi-Cal, and roughly 40,000 of those children have needed to change providers. That’s a little more than 6% of kids with new providers. According to DHCS numbers, less than 1% of transitioned children had to change health plans.

The more difficult phases of the transition begin with Phase 3 next week, on Aug. 1. Phases 1 and 2 have been completed, and phases 3 and 4 will be completed by the end of the year. Most of the 146,000 children still in the Healthy Families program will make the switch during Phase 3.

The latter stages of the transition will be more complicated, Mollow said, and will have much higher rates of change — of both provider and health plan, she said.

Phases 1 and 2 she said, “were done with relative ease, they were pretty much on the same level,” Mollow said. “Of all the phases, 4 is the one with the most change, with more chance of [children needing] a new health plan and new primary care provider.”

Kelly Hardy, director of health policy for Children Now, said the department’s numbers so far roughly match expectations.

“Though I was thinking that [6%] number would be closer to zero for the first two phases,” Hardy said. “My definition of ‘very few’ is different than that.”

The real test comes next week, Hardy said, when Phase 3 starts.

“Those numbers so far indicate there needs to be proactive work by the department to make sure these kids are taken care of,” Hardy said. “Phase 3 is more problematic because these are the kids who are going to change plans.”

Phase 4 begins in October, with roughly 35,000 children who will eventually shift out of Healthy Families.

The total number of children making the transition, according to DHCS numbers, is about 768,000 — almost 100,000 children short of the 860,000 who were in the Healthy Families program at the start of 2013, when the transition began. That difference is consistent with the attrition rate in Healthy Families before the transition started, Mollow said.

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