Ambitious Transition Plan for Healthy Families

State officials this week submitted a four-phase strategic plan to eventually move 875,000 children from the Healthy Families program into Medi-Cal managed care plans.

Health care advocates have expressed some reservations and concerns about the transition. State officials have said they’re confident they’re ready to meet the deadlines that have been set for it. The new plan hopes to simultaneously improve quality of care for children and save the state money.

It will happen quickly. On Jan. 1, the state plans to launch the first phase of the transition, shifting 415,00 of the Healthy Families kids to a managed care plan.

There’s a lot that goes into that kind of move, and the state needs to spend the proper time to make that transition go smoothly, according to Kelly Hardy, director of health policy for Children Now.

“Honestly, it looks like we need more time to work together to make sure these kids are taken care of,” Hardy said. “This is a good start, but more time is needed to do this right, rather than rushing the transition.”

Hardy emphasized that her group and other children’s advocacy groups are all committed to making the transition work, and she was reluctant to offer any criticism. But she looked at the mountain of work ahead, at everything that needs to come together in less than three months, and the prospect is daunting, she said.

“The amount of time we have is the amount of time we have,” she said. “But providers and families aren’t even known yet, the provider rate isn’t known yet, some of the pieces of information are not yet out there.”

The project also still needs federal approval, and the state hopes to get that soon, preferably before the Nov. 1 deadline to start sending out notices to beneficiaries.

According to Norman Williams, director of public affairs for the Department of Health Care Services, the other details are being worked out now, so that a final version can be sent to CMS as soon as possible.

“We expect to finalize the adjusted provider rates in the next few weeks,” Williams said. “We will then submit them to CMS for final approval.”

The transition will be worth the effort being put into it now, Williams said.

“Through the transition we intend to create one program for all children in California in families who meet the eligibility requirements,” Williams said, which is for children in families up to 250% of federal poverty level.

He added, “These children will still receive comprehensive care, but it will be provided via Medi-Cal. The transition helps the state as we prepare for health care reform in 2014. It largely simplifies coverage options and provides additional benefits and lower costs for children at certain income levels. We will also achieve administrative efficiencies, General Fund savings, and provide a more consistent health plan contracting process while increasing plan accountability to provide high-quality services to children.”

Williams said that mailings to eligible beneficiaries will be sent out in each of the four transition phases. “The letters are currently under development and are being coordinated with the Managed Risk Medical Insurance Board,” Williams said.

The children are at the center of the transition and all of the planning has been done with them in mind, Williams said.

“The state is prepared to implement this transition,” he said. “We will do it carefully, taking about nine months to transition all of the 875,000 children to Medi-Cal. Medi-Cal contracts with almost all of the Healthy Families’ plans and providers, so children will continue to receive the same high level of access to quality primary and specialty care. The goal is to ensure children are able to stay in the same plan and see the same provider.”