Mandatory Enrollment of Seniors and Persons with Disabilities in Medi-Cal Managed Care |
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A: Many seniors and persons with disabilities, approximately 380,000 people, will have to join a Medi-Cal managed care plan if they live in one of the 14 counties on the list below:
But not everyone in these counties will be affected. You do not have to enroll in a managed care plan if:
Q: When will these changes take effect? A: Mandatory enrollment will depend on your birth month. Mandatory enrollment will begin in June 2011 for people with birthdays in June; it will begin in July for people with birthdays in July, and so forth. This process will continue for one year, through May 2012. A: Managed care means that you receive your health care from a managed care plan. A managed care plan is an organized network of health care providers, which emphasizes primary and preventive care. Hospitals, physicians and other health care providers are members of the network. The managed care plan can be public or private. A: Yes. Managed care plans can provide you with the following:
Q: If I’m in managed care, can I keep the same doctors I have now? A: Ordinarily, your doctor must be part of the managed care network. However, if you now have a doctor who is not part of the managed care network, you can keep that doctor; but only if the doctor is both willing to keep seeing you and willing to accept the managed care network’s payment rate or the Medi-Cal fee-for-service rate, whichever is higher. The doctor becomes a part of the managed care network just for purposes of caring for you. The doctor will have access to network providers for purposes of referrals, etc. A: The Medi-Cal managed care plan can help you find a doctor's office that will meet your special needs. Your doctor and the health plan will be responsible for helping to coordinate your care. This includes helping you find the specialists you need. In addition, the managed care plan has telephone advice nurses to answer your health questions and customer service call centers to answer questions about your benefits. A: No. However, if you have a “complex medical condition” the managed care plan must provide continuous care with your current provider for up to one year after you enroll in the managed care plan. This is true whether or not the provider is willing to accept the managed care network’s payment rate. The state is finalizing requirements for this “exceptions process.” A: No. A: You should be getting letters and phone calls beginning about 90 days before you are required to enroll. The letters and phone calls will explain the steps you need to take and the options for managed care providers in your area. Q: I don’t have to enroll in managed care but I want to. Is it possible for me to enroll voluntarily? A: Yes, as long as your county has at least one managed care network that accepts Medi-Cal. Q: How can I find out more about the managed care plans in my area and pick the best one for me? A: You can find information about Medi-Cal managed care on the Health Care Options (California Department of Health Care Services) website: http://www.healthcareoptions.dhcs.ca.gov/HCOCSP/Home/. You can also call Health Care Options at: 1-800-430-4263. There are also contact numbers for languages other than English. Here is the list:
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