The Department of Health Care Services (DHCS) is releasing for stakeholder comment DRAFT enrollment materials for beneficiaries eligible to enroll in the Cal MediConnect program. DHCS is releasing these materials for comment to the beneficiary notification workgroup.
The goal of these materials is to ensure beneficiaries understand their choices. The materials include:
- Notices. These are the template notices that will be modified for different enrollment scenarios, such as those in a Special Needs Plan or skilled nursing setting. These notices will be mailed to beneficiaries at 90, 60, and 30 days prior to an individual’s scheduled date of passive enrollment into Cal MediConnect.
- Health Plan Guide. This will be mailed to beneficiaries in the 60-day mailing, along with the notice and a “choices” book that will have specific information about the health plan choices in that beneficiary’s county. Inside the “choices book” will be a “health plan choice form.” Beneficiaries can use this form to notify the state if they wish to make a choice other than the Cal MediConnect plan chosen for them through the assignment process. Beneficiaries also can call the toll-free number included in the notices to tell the state about their choice.
Please submit your comments on these materials to info@calduals.org by Friday, June 14, 2013 using the comment template.
For commenting purposes, please note that:
These materials have been tested on beneficiaries and revised based on that feedback. The materials have not yet been professionally designed. Your comments will be most helpful on the specific text and not the design.
When the content is finalized the materials will undergo a final literacy review to ensure they are written at no more than a sixth-grade reading level. All the materials will be translated into the threshold languages required for each county and will be available in accessible formats.
First (90 day ) draft letter comments:
It might be good to also highlight and separate into a separate paragraph:
“You will get a second letter in one month with more information about your choices. Then, you must make a choice about enrolling in a health plan or the State of California will choose for you.”
Towards the beginning of this first notice the date by which the health plan must be eventually chosen should be included — even if the health plan is not to be chosen at that point. Providing a date from the outset might make it easier to for the beneficiary to think of it as something with a deadline down the road, help to plan, etc.
SECOND LETTER (60 day notice letter)
The date by which a health plan must be chosen should also be at the beginning of the letter.
It would be helpful to have a number to call in case after one looks through all the health plan options one decides or sees that they may not be able to get the care they are currently getting or need through any of the plans from which they have to choose and to then ask for advice and provide feedback (which can then be used to change the design of the system to better serve those with more specialized care needs.
I might also be helpful to broaden the list of exemptions from Medi-Cal managed care beyond those listed to ensure that those who might need specialized care that that might be difficult to get though any of the health plans available to them on a long term basis.
Third letter.
If some patients get these letters while hospitalized or very ill or otherwise overburdened when they might not be able to do much about looking into health plans or do anything at all, perhaps there should be a number to call or form to use to state that one needs a little more time and why.
It would be good to include email contacts for questions and links to websites that contain information about the transition. This might be helpful in documenting recording of choices and communication and encourage more use of online resources and modes of communication.