The Department of Health Care Services (DHCS) is re-releasing for stakeholder comment DRAFT enrollment materials that will be distributed to beneficiaries eligible to enroll in the Cal MediConnect program. Comments on the materials were received in June and the materials have been revised based on those comments and feedback from beneficiaries. DHCS is re-releasing these materials for additional comments and discussion.
The goal of these materials is to ensure beneficiaries understand their choices.
The materials include:
- 90 and 60 day Notices. These are template notices that will be customized for different enrollment populations, such as beneficiaries in a Dual Eligibles Special Needs Plan or in a skilled nursing facility. These notices will be mailed to beneficiaries at 90 and 60 days prior to an individual’s scheduled date of passive enrollment into Cal MediConnect.
- Cal MediConnect Health Plan Guidebook. This will be mailed to beneficiaries immediately following the 60 day notice, to ensure the notice stands out to members. The Health Plan Guidebook explains to the beneficiary their health plan choices, how to choose a health plan, what their rights and responsibilities are after they join a health plan, and also provide additional resources and information such as toll free phone numbers and common terms and definitions.
- Click here to access the draft 90 day notice.
- Click here to access the draft 60 day notice.
- Click here to access the draft health plan guidebook.
Please submit comments to info@calduals.org by Friday, October 18, 2013, and please use the Comment Template.
For commenting purposes, please note that:
These materials have been formatted by DHCS’ Health Care Options Branch. Comments will be most helpful on text rather than 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 required Medi-Cal threshold languages, and will be available in accessible formats.
Please email questions to info@calduals.org.
90 Day Notice Comments:
Page 1: I think the letter should more directly state that the beneficiary must choose a managed care plan in the first paragraph of the letter. Substituting “You must now join a managed care health plan.” for “You will now have more choices to meet your health care needs.” might accomplish that.
Page 2: The statement “You keep the benefits and services you have now and your doctors and providers will work with your health plan.” could mislead the beneficiary to believe that their present doctors and providers would be a part of whatever plan they might choose. Better wording might be: “You keep the benefits and services you have now and the doctors and providers in the plan that you choose will work with your health plan.”
Statements like “The change helps you because your Medicare and Medi-Cal benefits work together and work better for you.” are presumptive. “The change may help you because your Medicare and Medi-Cal benefits will work together and may work better for you.” would better allow for a range of outcomes.
In the “What should I do now section”:
Perhaps include a suggestion that the beneficiary ask questions like: “Will I be able to see my current doctors or go to the same places where I currently to receive my medical care?” for each plan that is under consideration. “If I make a change and then go back to my old plan will I be able to go back to the doctors and providers I used to see?” “Will I be able to see any doctor in the plan when I join the plan or only the doctors who are taking new patients?”
90 Day Notice Comments:
Page 1: I think the letter should more directly state that the beneficiary must choose a managed care plan in the first paragraph of the letter. Substituting “You must now join a managed care health plan.” for “You will now have more choices to meet your health care needs.” might accomplish that.
Page 2: The statement “You keep the benefits and services you have now and your doctors and providers will work with your health plan.” could mislead the beneficiary to believe that their present doctors and providers would be a part of whatever plan they might choose. Better wording might be: “You keep the benefits and services you have now and the doctors and providers in the plan that you choose will work with your health plan.”
Statements like “The change helps you because your Medicare and Medi-Cal benefits work together and work better for you.” are presumptive. “The change may help you because your Medicare and Medi-Cal benefits will work together and may work better for you.” would better allow for a range of outcomes.
In the “What should I do now section”:
Perhaps include a suggestion that the beneficiary ask questions like: “Will I be able to see my current doctors or go to the same places where I currently to receive my medical care?” for each plan that is under consideration. “If I make a change and then go back to my old plan will I be able to go back to the doctors and providers I used to see?” “Will I be able to see any doctor in the plan when I join the plan or only the doctors who are taking new patients?”
60 Day Notice comments:
Pages 1-3: See comments made on 90 day notice.
60 Day Notice comments:
Pages 1-3: See comments made on 90 day notice.
Draft Health Plan Guide Book Comments:
Page 6: Should “Medi-Cal will not change.” be “Your Medicare will not change.”?
Besides describing what beneficiaries will receive or how they might benefit from each of the types of options, maybe also include what they will not get with each of the options as opposed to the others.
To help beneficiaries make choices appropriate to their needs include a list of questions they might ask when they inquire into each option.
Draft Health Plan Guide Book Comments:
Page 6: Should “Medi-Cal will not change.” be “Your Medicare will not change.”?
Besides describing what beneficiaries will receive or how they might benefit from each of the types of options, maybe also include what they will not get with each of the options as opposed to the others.
To help beneficiaries make choices appropriate to their needs include a list of questions they might ask when they inquire into each option.