Rural Frail, Elderly Beneficiaries Being Shifted to Medicaid Managed Care Plans

This week, state health officials launched a new phase in the rural expansion of Medi-Cal managed care, moving about 24,000 medically complicated seniors and the disabled into managed care plans.

Coincidentally, the annual conference of the California State Rural Health Association convenes on Wednesday in Sacramento.

The transition of seniors and persons with disabilities in rural areas into Medi-Cal managed care plans started Monday. The shift in care affects the SPD population in 19 rural counties. 

“This week will be a week of transition for these members,” said Anthony Cava, information officer at the Department of Health Care Services, which oversees Medi-Cal. “Affected members received three notices at 30, 60 and 90 days prior to transition and two outreach calls to assist them with their managed care health plan choice.”

Cava said one goal of switching to managed care is to provide more comprehensive care management.

“Members will receive the same care they did under the fee-for-service system, but with the benefit of having a coordinated, integrated health plan that will meet their medical, dental, mental health, substance use disorder treatment services and long-term care needs,” Cava said.

SPDs generally have multiple chronic conditions, along with many different providers and medications. The state’s 2011 transition of the non-rural SPD population did not go smoothly, and there were many reported lapses and gaps in care. Cava said the state has learned from that experience.

“DHCS and CMS solicited stakeholder input to ensure a thoughtful transition for SPDs in these counties,” he said. “DHCS has also had multiple conversations with CMS to address any concerns regarding the mandatory enrollment of SPDs in these counties. These conversations included an evaluation of lessons learned from previous mandatory SPD transitions to ensure that this population will transition smoothly from Medi-Cal fee-for-service to managed care in the rural counties.”

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Capitol Desk Medi-Cal