22-545m Members Get Better, Simpler Medi-Cal from Mandatory Medi-Cal Enrollment
Date: 07/22/22
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.
This information applies to Medi-Cal in Fresno, Kings and Madera counties.
The requirements support CalAIM
Effective January 1, 2023, the Department of Health Care Services (DHCS) will be transitioning Medi-Cal beneficiaries who are currently excluded from or voluntary for managed care plan (MCP) enrollment into an MCP. They will no longer be permitted to remain in the fee-for service (FFS) delivery system.
How does this affect patients?
CalAIM seeks to move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility through mandatory managed care enrollment (MMCE) and benefit standardization.1
Statewide, standardized enrollment and benefits can enhance coordination of care and reduce complexity across the Medi-Cal program. Standard enrollment processes will help ensure populations moving between counties are subject to the same enrollment requirements, thereby eliminating variances in benefits according to aid code, population and geographic location.1
How does this affect providers?
As of January 1, 2023, providers may see an increase in the number of CalViva Health Medi-Cal patients they serve. The number of FFS patients they see will decrease.
Relevant sections of the provider operations manuals will be revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library after logging in to the provider website > Provider Library under Quick Links, or go directly to provider library.
1Information from DHCS All Plan Letter 21-015.