News & Updates
NEW MLTSS Enrollment Materials Finalized
Managed Care Resource Guide and Choice Book for New Dual Eligible Beneficiaries in CCI Counties
The Department of Health Care Services (DHCS) is proud to announce the new Medi-Cal Managed Care Plan Resource Guide and Choice Book.
These materials will be mailed to two groups of dual eligible beneficiaries as a part of their regular enrollment process:
• New dual eligible beneficiaries who have Medicare first and later gain Medi-Cal eligibility in CCI counties; and
• Existing dual eligible beneficiaries who move into a CCI county.
All of these beneficiaries are already required to enroll into a Medi-Cal managed care health plans (MCP) for their Managed Long-Term Services and Supports (MLTSS) in order to receive their Medi-Cal benefits. These new materials will ensure that this group of beneficiaries receives information on all of their available options – including Cal MediConnect.
The new materials incorporate some of the lessons learned about how to most effectively communicate with dual eligible beneficiaries about the CCI, including feedback from stakeholder input and beneficiary testing. Prior to being finalized, these materials underwent a final literacy review to ensure that they meet readability standards and are not above a sixth-grade reading level. All final materials are also being translated into threshold languages and will be available in accessible formats, as required.
Click below to access the new MLTSS enrollment materials:
Highlighted Outreach Events
8/4 – In partnership with California State Council on Developmental Disabilities (SCDD) and HICAP, state outreach staff provided a presentation for case managers and social workers from the Inland Regional Center. Following the presentation, attendees participated in conversations and asked questions about real cases and questions they encounter through their work. Future collaborative presentations are scheduled this year, see the CalDuals.org outreach calendar for more details.
Santa Clara County
8/10 – Caregivers at the Alzheimer’s Activity Center learned more about the CCI during a presentation that included information on benefits, how to join, and eligibility. Attendees asked questions about the program, the benefits of joining Cal MediConnect, and how the program works with adult day centers and other long-term services and supports.
8/16 – In collaboration with Molina Healthcare, state outreach staff educated beneficiaries about the CCI at the City of Perris Senior Center. Over a dozen seniors, including a monolingual Spanish-speaking group, gathered to learn more about Cal MediConnect, care coordination, the benefits of joining, and how the program works with their current providers.
San Diego County
8/22 – Outreach coordinators and certified enrollment counselors with Health Quality Partners (HQP) learned more about the CCI during a presentation which covered Cal MediConnect, recent changes to the continuity of care policy, and the value of coordinated care. Attendees asked questions that about topics they encounter as they work with beneficiaries, such as eligibility, the enrollment process, and the benefits of joining the program.
Los Angeles County
8/27 – Seniors and their family members attended the 48th Assembly District Community Health Fair to learn about Cal MediConnect and other health services available in their district. A presentation focused on Cal MediConnect eligibility, the terms of continuity of care, care coordination, and the health plans available to beneficiaries. The health fair also featured free health screenings and other healthy activities. The event was hosted by Assemblymember Roger Hernandez.
San Diego County
8/31 – Congregational Community Church organized a Cal MediConnect outreach session for its members who qualify for the program. The discussion focused on the importance of care coordination, the benefits available through Cal MediConnect, continuity of care, and how to join. The group asked many questions about eligibility, balance billing, and the available health plans. Attendees received copies of the new Beneficiary Toolkit and people reported the material was easy to understand and helpful.
Other Recent Outreach Events
Los Angeles County:
August 12: Informational table for beneficiaries at Homeless Care Days Resource Fair.
August 15: Informational table for seniors and their family members during Promotion Day at Anderson Munger Family YMCA.
August 18: Webinar for Los Angeles County advocates.
August 19: Webinar for Los Angeles County providers.
August 23: Presentation for psychiatric social workers at the Los Angeles County Department of Mental Health.
August 23: Presentation for billing staff at the Los Angeles County Department of Mental Health.
August 25: Presentation to seniors at El Monte Senior Center.
August 31: Presentation for members of the East Los Angeles Disability and Senior Collaborative.
August 31: Presentation for seniors at City of Montebello Senior Center.
August 31: Presentation to Molina Healthcare Provider Outreach Staff at its headquarters in Long Beach.
August 26: Informational table for seniors at Homeless Care Days Resource Fair.
August 20: Informational table at the Super Senior Saturday Resource Fair.
August 24: Presentation for staff and beneficiaries at Give for a Smile.
August 30: Webinar for Orange County advocates, stakeholders and caregivers.
August 31: Webinar for Orange County Providers.
Riverside and San Bernardino Counties:
August 16: Webinar for Inland Empire advocates.
August 17: Webinar for Inland Empire providers.
August 23: Informational table for seniors at the Eastside Senior Fitness Fair Expo.
San Diego County:
August 1: Presentation for providers at the monthly National City Collaborative Partners meeting.
August 2: Presentation for Filipino-American seniors at the Paradise Valley Community Church & Services Food Distribution event.
August 11: Community Health Improvement Partners Behavioral Work Group meeting.
August 16: Presentation for volunteers at the AARP Chula Vista Community Action Team meeting.
August 30: Webinar for San Diego providers.
Santa Clara County:
August 18: Webinar for Santa Clara Physicians and other medical providers.
August 19: Webinar for Omayra Ortega.
August 22: Informational table for homeless advocates at the Winter Faith Collaborative.
The Department of Health Care Services developed the Cal MediConnect Beneficiary Toolkit to support beneficiaries, their caregivers and key supports, and options counselors in helping choose the best health plan option. Beneficiaries and their caregivers should use this toolkit along with information provided in formal notices and guidebooks.
Robust beneficiary outreach and education is a core part of the design and implementation of the Coordinated Care Initiative (CCI) and Cal MediConnect. Beneficiary outreach is focused on two main goals: 1) ensuring eligible beneficiaries understand the Cal MediConnect program and can make an educated choice about whether it is right for them and 2) making the enrollment process simpler and easier for beneficiaries.
Early evaluation data on the Cal MediConnect enrollment process indicated that beneficiaries could benefit from specific additional information and materials about the CCI program. Beneficiaries are particularly interested in information about how to retain their current doctors and how to make decisions about their new coverage options. In response, DHCS developed new materials to support beneficiaries and their providers and caregivers in the decision-making process.
To ensure optimal usability of the toolkit, a broad range of stakeholders reviewed it and the UC Berkeley School of Public Health’s Health Research for Action center conducted user testing with beneficiaries.
This toolkit can be a resource for health plans, advocates, and community organizations, including HICAPs and the Ombudsman, that engage directly with beneficiaries. DHCS continues to update and develop new tools for state outreach coordinators and other community organizations to use in outreach and education activities for beneficiaries.
The Department of Health Care Services updated the Coordinated Care Initiative Physician Toolkit to provide physicians with information about how the Coordinated Care Initiative (CCI) is changing health care for dual-eligible patients. The updated toolkit outlines the coverage options for patients and how these changes could affect the billing process, care coordination, and other aspects of a physician’s practice.
In 2016, DHCS worked with stakeholders to develop a comprehensive strategy to improve the CCI and increase enrollment. This updated toolkit reflects the resulting recent program changes, including an extended continuity of care period.
Robust provider outreach and education is a core part of the design and implementation of the CCI and Cal MediConnect. This toolkit can be a resource for health plans, advocates, and community organizations. DHCS continues to update and develop new tools to use in outreach and education activities for providers.
Highlighted Outreach Events
7/20 – Alzheimer’s Orange County in Irvine hosted an OneCare Connect Informational Forum and Resource Fair for stakeholders, caregivers, and advocates. The event, which focused on post-passive enrollment, included a presentation on the CCI and OneCare Connect. The SCAN Foundation shared information on the latest CCI survey and advocates, stakeholders, and community-based organization representatives had the opportunity to ask questions about OneCare Connect. CalOptima, HICAP, Legal Aid Society of Orange County, Alzheimer’s Orange County, Regal Medical Group, AltaMed Health Services, and agencies staffed resource tables and attendees had the opportunity to get more information for the seniors they serve in Orange County.
Los Angeles County
7/28 – Staff members at the Los Angeles County Department of Mental Health learned about Cal MediConnect at the SA4 Housing Consortium. Social workers asked questions about health plans in Los Angeles County, how to access Medi-Cal services under the program, and about Cal MediConnect’s benefits. Attendees were also able to access a behavioral health services matrix that helped social workers identify the variety of available services and which agency covers that benefit.
San Diego County
7/6 – State outreach staff presented to staff of Windsor Gardens San Diego Rehab and Nursing. Senior care case workers, home health coordinators, and hospice and palliative caregivers from learned about Cal MediConnect’s care coordination benefits, continuity of care provisions, and the available health plan options. Outreach staff gave detailed information on coordinated care and explained how the program provides health risk management, patient-centered care, and interdisciplinary care.
7/21 – Outreach staff gave an update on the CCI’s implementation as part of the San Diego Regional Home Care Council meeting. The discussion highlighted the coordination of Medicare and Medi-Cal benefits for the dually eligible population, along with information about eligibility, beneficiary protections, and the health plan options available. Members of San Diego’s Regional Home Care Council provide home care services to seniors in the county, including insurance brokers. Following the meeting, several council members requested future CCI in-services for their facilities and teams.
Santa Clara County
7/11 – Chinese-speaking seniors and case managers participated in a CCI presentation. With the help of an interpreter, attendees learned about the programs benefits, protections, and options. They also had the change to ask questions about keeping their current providers, requesting continuity of care, and the availability of dental benefits in the plans. Case managers mentioned that seniors who aren’t able to chew properly could face nutritional issues and disease, and that some medications require food to be taken with them. Case managers requested follow-up presentations in the future.
7/27 – Seniors enrolled in Anthem and Santa Clara Family Health plan learned more about Cal MediConnect at a Consumer Advisory Meeting. The presentation included an update on outreach activities, new materials, upcoming events, and member satisfaction information. Attendees who participated said they were very satisfied with the program. Participating seniors gave the presenter suggestions as to where further outreach could be conducted, including at food pantries and a clinic that predominantly serves seniors.
Other Recent Outreach Events
Los Angeles County:
7/8 – Informational table for beneficiaries and service providers at Homeless Care Days Resource Fair.
7/8 – Presentation to UCLA medical students at Homeless Care Days Resource Fair.
7/14 – Informational table for Spanish-speaking beneficiaries and caregivers at the Alzheimer’s y los Latinos Resource Fair at Plaza México.
7/22 – Informational table for beneficiaries and service providers at Homeless Care Days Resource Fair.
7/30 – Informational table for beneficiaries and caregivers at the 21st Annual Central Ave Jazz Festival Health Factory.
7/26 – Webinar for Orange County Advocates and Stakeholders.
7/26 – Webinar for Orange County Providers.
Riverside and San Bernardino Counties:
7/20 – Presentation for the County of Riverside Consumers Affairs Department.
San Diego County:
7/7 – Presentation for San Diego County Council on Aging.
7/12 – Presentation for community advocates and senior service providers from the County of San Diego’s Aging & Independent Services.
7/14 – Presentation at the monthly Behavioral Health Workgroup meeting.
7/21 – Webinar for San Diego providers.
7/26 – Presentation for community-based organizations, health care providers at the Health and Human Services Agency’s San Diego South County Action Team Meeting.
7/27 – Presentation for the Community Action Council of San Marcos and Palomar Healthcare System.
Santa Clara County:
7/7 – Presentation for homeless seniors and service providers in San Jose.
7/22 – Informational table for beneficiaries and caregivers at the Los Gatos Library.
7/25 – Informational table for beneficiaries and homeless advocates at the Winter Faith Collaborative.
7/28 – Informational table for beneficiaries, caregivers, and advocates at the Senior Commission Institutional Care and Protective Services.
The UCSF Community Living Policy Center and the UC Berkeley Health Research for Action Center conducted an evaluation of Cal MediConnect (CMC), part of California’s Coordinated Care Initiative (CCI). The evaluation uses focus groups and a representative telephone survey to assess beneficiaries’ experiences with care, including access, quality, and coordination. The evaluation also examines service delivery system response to the initiative in several sectors, including health plans, medical care providers, behavioral health, skilled nursing, and home and community-based services.
As part of this three-year evaluation, in early 2016 researchers conducted a representative telephone survey with 2,139 beneficiaries who were dually eligible to examine their experiences with Cal MediConnect. Researchers compared the experiences of CMC beneficiaries with those who opted out and those who reside in non-CCI counties to identify areas where experiences are significantly better or worse than those who did not participate.
Key findings from the telephone survey include:
- Most Cal MediConnect beneficiaries are satisfied with their benefits.
- Continuity of care is important to beneficiaries.
- Access to care improved for about a quarter of beneficiaries in CMC, with the most significant improvements seen in the areas of prescription medication, equipment or supplies, vision, and dental benefits.
- Care coordination from Cal MediConnect plans is working well and having a care coordinator helped ease the transition into Cal MediConnect.
- Cal MediConnect plans are coordinating LTSS, but more needs to be done to reduce unmet needs for those needing personal care assistance.
- Cal MediConnect notifications showed room for improvement.
- Beneficiaries had many reasons for opting out of Cal MediConnect that reach beyond “fear of change.”
For full details of the telephone survey findings and the complete evaluation, including comments from the California Department of Health Care Services, click here or visit www.thescanfoundation.org.
The Department of Health Care Services (DHCS) will begin streamlined enrollment the week of August 22, 2016, for Cal MediConnect as part of the Coordinated Care Initiative (CCI).
Streamlined enrollment allows Cal MediConnect health plans to submit enrollment changes to DHCS on behalf of their members. This will provide a simpler method for beneficiaries to enroll in the Cal MediConnect product associated with their Medi-Cal managed long-term services and supports (MLTSS) health plan as they will no longer have to take the extra step to contact the state enrollment broker, Health Care Options (HCO), to complete their enrollment choice.
Providing streamlined enrollment is part of DHCS’s comprehensive strategy for improving the CCI and Cal MediConnect program. This comprehensive strategy focuses on improving the quality of care and care coordination beneficiaries receive through Cal MediConnect, ensuring that beneficiary satisfaction remains high and the program remains sustainable.
Streamlined enrollment builds on lessons learned about effective beneficiary outreach, including that the best way to educate beneficiaries is through one-on-one conversations that answer their specific questions about their providers and the program and how to make a smooth transition. It will also be a beneficiary-friendly enrollment procedure, eliminating an extra step for beneficiaries to take to have their enrollment choice effected.
DHCS has safeguards in place to protect beneficiaries. Safeguards include HCO and the health plan both contacting the beneficiary to confirm their choice. Stakeholders have provided feedback on call scripts to ensure they are straightforward and understandable. Beneficiaries will still have the right to change their plan or disenroll from Cal MediConnect. HCO will continue to be a resource for beneficiaries to ask questions and effect enrollment changes. DHCS will continue to closely monitor this process and work with the plans to ensure the process is smooth and beneficiary protections are working.
Today, DHCS is issuing an updated continuity of care provider bulletin, which explains how current out-of-network physicians can continue seeing Cal MediConnect beneficiaries and the process for billing the correct entity for payment. It also provides information to help combat balance billing.
Earlier this year, DHCS announced that it would extend the continuity of care period for Medicare services from six months to 12 months to match the Medi-Cal continuity of care period, and modify requirements to just one visit with a specialist within the past 12 months, as is the case with primary care physicians. These policy changes will be effective starting October 1, 2016. DHCS has updated its Duals Plan Letter and this new provider bulletin also reflects these changes.
In order to ensure that beneficiary transitions into Cal MediConnect are smooth and do not result in disruptions in care, the Cal MediConnect continuity of care policy provides beneficiaries in Cal MediConnect plans with the right to continue seeing non-participating physicians for a limited period of time.
Today, researchers at the University of California (UC) San Francisco and UC Berkeley released new findings from their three-year evaluation of Cal MediConnect and the Coordinated Care Initiative.
The UC’s evaluation – funded by The SCAN Foundation – includes interviews with various stakeholders including Cal MediConnect health plans, provider groups, long-term care facilities, In-Home Supportive Services (IHSS), Multipurpose Senior Service Program (MSSP), Community Based Adult Services (CBAS), hospitals, state and federal government, and community based organizations. The study evaluates the impact of the Cal MediConnect on beneficiaries as well as the overall health system, identifies areas for improvements, and includes recommendations to better coordinate care for dual eligible beneficiaries.
DHCS appreciates the various evaluation efforts supported by The SCAN Foundation, and is encouraged by early evaluation data showing that beneficiaries in Cal MediConnect health plans are confident in and satisfied with their care.
The report credits Cal MediConnect for building stronger relationships between the plans and various stakeholders including providers, community organizations, and long-term services and supports. For the dual-eligible population, Cal MediConnect continues to provide a platform for increased collaboration among historically independent or ‘siloed’ programs and providers. The report identifies collaboratives as a key factor in promoting communication and shared learning, especially within large counties.
In addition, the study reported strong evidence of Cal MediConnect delivering on its promise of care coordination among the dual-eligible beneficiaries. It recognized Cal MediConnect’s success in developing and expanding innovative care coordination programs among the health plans. The report highlights the significant improvement in the “culture of care.”
The report also identifies several areas for improvement. DHCS and its partners recognize and are finding solutions for the challenges of integrating different health care systems so that care is coordinated and improved for all Cal MediConnect beneficiaries. DHCS appreciates the recommendations of this report, and will integrate this valuable information into new and ongoing projects to improve Cal MediConnect.
Critically, the report calls out the continued need to strengthen connections with long-term services and supports (LTSS), and DHCS is working on several fronts to address this concern. DHCS is taking several steps to encourage broader use of LTSS services. DHCS is working with stakeholders to standardize the Health Risk Assessment (HRA) questions designed to prompt referrals for non-medical or LTSS needs. Furthermore, we are strengthening data collection around LTSS referrals to better track how effectively plans are linking beneficiaries to needed services.
DHCS looks forward to continuing to work with plans and stakeholders to continue to strengthen the program.
UC Report & Key Findings and Recommendations:
More information on various evaluation efforts:
Earlier this year, the Department of Health Care Services (DHCS) shared for stakeholder comment a comprehensive strategy for the Coordinated Care Initiative (CCI). This strategy focused on improving the quality of care and care coordination beneficiaries receive through Cal MediConnect, ensuring that beneficiary satisfaction remains high and increases, and generating sustainability for the program. After considerable feedback from stakeholders, DHCS announced final policy decisions in May. Today, DHCS is sharing an update on these policy decisions, as well as an additional document for stakeholder comment.
Voluntary Enrollment Strategy
DHCS announced its intent to pursue a robust voluntary “opt-in” enrollment effort for the remainder of 2016. Today, DHCS is releasing its DRAFT Cal MediConnect Voluntary Enrollment Strategy for stakeholder comment. It is available here.
This strategy, designed to expand awareness of Cal MediConnect and encourage voluntary enrollment, builds on activities DHCS and its partners are already conducting. This strategy also incorporates many of the lessons learned about how best to reach and educate beneficiaries and providers about the CCI and Cal MediConnect. These strategies include streamlined enrollment and mandatory Medi-Cal plan enrollment for managed long-term services and supports (MLTSS).
DHCS is soliciting feedback from stakeholders on the activities included in this strategy, as well as additional activities Cal MediConnect partners can pursue. Feedback is due Thursday, July 14, 2016.
Standardized LTSS HRA Questions & Data Measures
DHCS announced that it would strengthen LTSS referrals and improve care coordination by standardizing the Health Risk Assessment (HRA) referral questions for LTSS to reflect the best practices developed over the early years of the program and expanding data collection and reporting.
DHCS released draft HRA referral questions in June and received valuable stakeholder feedback. In response to that feedback, and given the importance of selecting the most effective questions, DHCS will convene a small workgroup in order to identify and agree on a final list of questions that will best meet the needs of beneficiaries.
DHCS appreciates the feedback it received on the draft revised data measures and will share final measures later this month.
Provider Opt Out Data
DHCS has shared with Cal MediConnect health plans the detailed analysis of beneficiaries who have opted out of the program, and their most frequently used providers, in order to more effectively focus provider education and outreach activities. We have begun discussions with the plans on opportunities for partnership on education and outreach activities.
Best Practices Meetings
DHCS held the first in a series of meetings with Cal MediConnect plans to share best practices and ensure all plans are performing to the highest standard. Moving forward, DHCS will convene these meetings regularly. DHCS is asking that stakeholders submit topics for consideration at future meetings to firstname.lastname@example.org on an ongoing basis.
Continuity of Care
DHCS announced that it would extend the continuity of care period for Medicare services from six months to 12 months to match the Medi-Cal continuity of care period, and modify requirements to just one visit with a specialist within the past 12 months, as is the case with primary care physicians. DHCS is working with CMS and Cal MediConnect plans to update its Dual Plan Letter and prepare for implementation in late Fall 2016.
Streamlined enrollment will provide a simpler method for beneficiaries to enroll in the Cal MediConnect product associated with their existing MLTSS plan. DHCS has begun operational testing with the plans and will begin streamlined enrollment later this summer, with formal notification of the official start date to come.
The new Cal MediConnect and MLTSS Resource Guide and Choice Book has gone through the University of California’s beneficiary user testing process and is being finalized. DHCS anticipates ongoing mandatory enrollment of MLTSS-eligible beneficiaries into MLTSS plans will begin in Fall 2016. The final Resource Guide and Choice Book will be made available on CalDuals.org.
Beneficiary Took Kit
The Cal MediConnect Beneficiary Toolkit has gone through the University of California’s beneficiary user testing process and a final version will be posted on CalDuals.org by the end of July.
Stakeholder engagement and input is critical to the success of the CCI. All stakeholder feedback on the voluntary enrollment strategy is due by Thursday, July 14, 2016. DHCS is requesting all questions and comments be sent to email@example.com. DHCS is committed to transparency and will share additional materials for stakeholder input as they become available.
Thank you for your continued support of the CCI.