The Managed Risk Medical Insurance Board, which oversees the state’s Healthy Families program, yesterday took a long look at the first outline of a plan to facilitate the state-ordered shift of an estimated 873,000 children enrolled in the HF program to Medi-Cal managed care.
The conclusion was, the current time frame to make such a big change is too tight, said Janette Casillas, executive director of MRMIB.
“In this transition, it is not just an administrative process to move almost a million children,” Casillas told the board yesterday. “Whenever a child is disenrolled [in the Healthy Families program], there are seven different IT transactions to make, for example. There are three separate transactions to update meds.”
Dealing with that kind of complicated transition could be hard, she said, when you multiply all of that by 415,000 — the number of children slated for transition to Medi-Cal on Jan. 1, 2013. that’s almost half the kids in Healthy Families. The latest tally by MRMIB shows about 873,000 kids in the program, down from last monthâs 875,000. Another state agency — the Department of Health Care Services, which will oversee the children once they’ve shifted to Medi-Cal – estimated 880,000 kids in the program in June.
“We are looking at the transition plan, Phase 1, there are an estimated 415,000 in that first group,” Casillas said. “That’s 2.9 million transactions. That is a big ask for anybody, for any entity, to do. And not have a glitch in what you’re doing.”
Casillas said she’d like to stagger the transition for those 415,000 children over the first three months of the year.
“I am concerned about moving them on a given day,” she said. “I would much rather take a third of them one month, a third the next month and so on.”
MRMIB plans to work with the Department of Health Care Services to try to implement that change. The trailer bill language ordering the switch provides some date flexibility, Casillas said.
“The way the trailer bill is written, it says [the first group of 415,000 children] should make the change ‘no sooner than Jan. 1,’ ” Casillas said. “So if we split that first group into three equal groups, that could help.”
The plan outlined by Casillas is a complicated one. “This is only a draft, this is only a brainstorming session about the tasks that need to occur,” she said. “This is the first draft of many to come, to try to figure out all of the activities that should occur before we transition any of our kids to the Medi-Cal program.”
That plan includes notification of beneficiaries — by multiple letters, email, website updates and media ads and interviews — as well as doing a health plan network analysis to determine whether there is adequate access for such a large number of children, for general medical services as well as dental and vision care.
“We want to make sure we have continuity, and sufficient access for our children,” Casillas said.