Orange County Enrollment Update

***UPDATE 9.29.15: The timeline below has been re-linked to the timeline’s most recent version, which was created after this entry originally appeared.***

The Department of Health Care Services (DHCS) would like to share an update on Cal MediConnect passive enrollment in Orange County, as it relates to eligible beneficiaries residing in Long Term Care (LTC) facilities.

As you know, Cal MediConnect passive enrollment in Orange County begins on August 1, 2015. In Orange County, CalOptima refers to the Cal MediConnect option as OneCare Connect, and enrollment notices will come directly from CalOptima. DHCS and the Centers for Medicare and Medicaid Services (CMS) have worked with CalOptima to ensure plan readiness. CalOptima and DHCS have also engaged stakeholders to plan outreach and education activities for passive enrollment, building on lessons learned from other CCI counties.

Passive Enrollment in Orange County for Beneficiaries Residing in Contracted LTC Facilities

As the only Medi-Cal plan in Orange County, CalOptima has existing relationships with Cal MediConnect eligible beneficiaries. DHCS estimates that approximately 3,500 eligible beneficiaries reside in LTC facilities in the county. These beneficiaries tend to have complex health care needs, and can benefit from targeted and individualized outreach and education. Recognizing these needs, DHCS is approving CalOptima’s request to modify the passive enrollment timeline and process for these beneficiaries. Cal MediConnect eligible beneficiaries currently residing in a LTC facility will be withheld from the birth month passive enrollment process and instead will be noticed and passively enrolled on a LTC facility-by-facility basis.

Modifying the schedule and process will help CalOptima better serve these beneficiaries. It will enable closer coordination and face-to-face interactions between CalOptima staff and care coordinators, beneficiaries and their caregivers, and facility staff. It will allow for any necessary continuity of care to be in place, and make the transition to Cal MediConnect smoother for beneficiaries.

This process will begin no earlier than November 1, 2015, which means that no beneficiaries currently residing in a LTC facility will be passively enrolled until then. Beginning November 1, CalOptima will passively enroll beneficiaries residing in LTC facilities. Enrollment will be based on several factors such as common LTC facility ownership, geographic location, and number of eligible beneficiaries residing at each facility.

It is important to note that beneficiaries who move into LTC facilities after the November 1 passive enrollment period begins will be enrolled based on the birth month schedule. Also, beneficiaries residing in LTC facilities that do not contract with CalOptima will follow the birth month enrollment schedule. This change does not change existing continuity of care protections for beneficiaries who reside in LTC facilities – and beneficiaries will not be required to change nursing facilities, regardless of whether the facility participates.

For each facility, CalOptima will conduct pre-transition facility coordination and on-site educational events, as well as provide post-transition care team support. CalOptima will designate a specific team to work directly with these beneficiaries, their families, and facility staff at each LTC facility. The team will include a medical director, case manager, personal care coordinators, provider relations representative and enrollment coordinator, as well as representatives from HICAP and the Cal MediConnect Ombudsman. These beneficiaries will still receive the required 90-, 60-, and 30-day notices, and will also receive additional information with details on outreach and education events at their LTC facility.

A current timeline is posted here. CalOptima is currently working with the LTC facilities to finalize timing, and this document will be updated as necessary.

This proposal was developed in consultation with many stakeholders, including the CalOptima Member and Provider Advisory Committees, California Health Advocates (the Orange County HICAP), the Cal MediConnect, Medi-Cal, and Long Term Care Ombudsman programs, and the California Association of Health Facilities.

DHCS believes this person-centered outreach approach will allow CalOptima to conduct targeted outreach to these vulnerable beneficiaries, and meet their complex needs more effectively. DHCS is committed to ensuring that all of our beneficiaries have access to the high quality, coordinated care they deserve. DHCS will actively monitor progress and consult with stakeholders on the ground to ensure the process is working well for beneficiaries.

As always, your comments and feedback are very important to us. To share your comments or to ask a question about this announcement, please email info@calduals.org.

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