24-1014 Transitioning Foster Youth to Medi-Cal Managed Care Plans Starting January 1, 2025

Date: 10/18/24

Members will be notified in writing about their continuity of care protections

Beginning January 1, 2025, fee-for-service (FFS) Medi-Cal (regular Medi-Cal) will not be available in Imperial county for current and former foster care children and youth. The Department of Health Care Services (DHCS) will mandatorily enroll current and former foster care children and youth into a Medi-Cal managed care plan. Members transitioned into Medi-Cal managed care will be enrolled in Enhanced Care Management (including former and current foster youth up to age 26).

For more information about the Mandatory Enrollment for Foster Children and Youth in Single Plan Counties 2025 transition, providers may access the DHCS notice at DHCS Mandatory Enrollment.

Member notifications

DHCS will mail member notices to current and former foster youth Medi-Cal members in single plan counties 60 days and 30 days before January 1, 2025.

Continuity of care protections

• Individuals may be eligible for continuity of care protections to keep their Medi-Cal provider for up to 12 months. To qualify, members must meet the following criteria:

-   Member visited the provider at least once in the last 12 months. 

-   The provider is willing to work with member’s new health plan.

-   There are no quality of care issues with the provider.

• Prior Authorization and Treatment - Community Health Plan of Imperial Valley will continue to honor any prior authorization and active course of treatment for the full six-month period following the transition date and until reassessment for medical necessity of ongoing services is established.
• Durable medical equipment (DME) rentals and medical supplies – Members will be allowed to keep their existing DME rentals and medical supplies from their existing DME Providers without further authorization for the full six-month period following the transition date and until a reassessment has been completed and the new equipment or supplies are in the possession of the member and ready for use.

Additional information

Providers are encouraged to access the provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact Community Health Plan of Imperial Valley at 833-236-4141.

 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, Enhanced Care Management (ECM) Providers, and Behavioral Health Providers.

This information applies to Medi-Cal in Imperial county.