{"id":170,"date":"2011-03-23T16:07:00","date_gmt":"2011-03-23T16:07:00","guid":{"rendered":"https:\/\/abilitytools.org\/blog\/?p=170"},"modified":"2014-07-16T22:26:58","modified_gmt":"2014-07-16T22:26:58","slug":"mandatory-enrollment-of-seniors-and-persons-with-disabilities-in-medi-cal-managed-care","status":"publish","type":"post","link":"https:\/\/abilitytools.org\/blog\/mandatory-enrollment-of-seniors-and-persons-with-disabilities-in-medi-cal-managed-care\/","title":{"rendered":"Mandatory Enrollment of Seniors and Persons with Disabilities in Medi-Cal Managed Care"},"content":{"rendered":"
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Many people with disabilities receive medical care, including durable medical equipment and medical supplies, through California’s Medi-Cal system. California is rolling out Mandatory Managed Care for people with disabilities and seniors. The questions and answers below outline who is affected and explain the basics regarding the transition. A big thank you to Disability Rights California for sharing this important information.<\/span><\/div>\n

<\/i><\/span><\/span><\/div>\n
Written by Disability Rights California <\/o:p><\/i><\/span><\/span><\/div>\n

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California\u2019s Protection & Advocacy System <\/i><\/o:p><\/span><\/span><\/div>\n

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Q: I receive Medi-Cal. Will I have to enroll in managed care? <\/b><\/o:p><\/span><\/span><\/div>\n

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A: Many seniors and persons with disabilities, approximately 380,000 <\/o:p><\/span><\/span><\/div>\n
people, will have to join a Medi-Cal managed care plan if they live in <\/o:p><\/span><\/span><\/div>\n
one of the 14 counties on the list below:<\/span><\/span><\/div>\n
Alameda<\/span> <\/span><\/div>\n
San Bernardino<\/span><\/span><\/div>\n
Contra Costa<\/span><\/span><\/div>\n
San Diego<\/span><\/span><\/div>\n
Fresno<\/span><\/span><\/div>\n
San Francisco<\/span><\/span><\/div>\n
Kern<\/span><\/span><\/div>\n
San Joaquin<\/span><\/span><\/div>\n
Los Angeles<\/span><\/span><\/div>\n
Santa Clara<\/span><\/span><\/div>\n
Riverside<\/span><\/span><\/div>\n
Stanislaus<\/span><\/span><\/div>\n
Sacramento<\/span><\/span><\/div>\n
Tulare <\/o:p><\/span><\/span><\/div>\n

<\/span><\/div>\n
But not everyone in these counties will be affected. You do not have <\/o:p><\/span><\/span><\/div>\n
to enroll in a managed care plan if: <\/o:p><\/span><\/span><\/div>\n

<\/span><\/div>\n
1. You have Medicare as well as Medi-Cal <\/o:p><\/span><\/span><\/div>\n
2. You receive services from the California Children\u2019s Services <\/o:p><\/span><\/span><\/div>\n
(CCS) program, or <\/o:p><\/span><\/span><\/div>\n
3. You receive foster care or adoption assistance benefits <\/o:p><\/span><\/span><\/div>\n

<\/span><\/div>\n
Q: When will these changes take effect? <\/b><\/o:p><\/span><\/span><\/div>\n

<\/span><\/div>\n
A: Mandatory enrollment will depend on your birth month. <\/o:p><\/span><\/span><\/div>\n
Mandatory enrollment will begin in June 2011 for people with <\/o:p><\/span><\/span><\/div>\n
birthdays in June; it will begin in July for people with birthdays in July, <\/o:p><\/span><\/span><\/div>\n
and so forth. This process will continue for one year, through May <\/o:p><\/span><\/span><\/div>\n
2012. <\/o:p><\/span><\/span><\/div>\n

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Q: What is managed care? <\/b><\/o:p><\/span><\/span><\/div>\n

<\/span><\/div>\n
A: Managed care means that you receive your health care from a <\/o:p><\/span><\/span><\/div>\n
managed care plan. A managed care plan is an organized network of <\/o:p><\/span><\/span><\/div>\n
health care providers, which emphasizes primary and preventive <\/o:p><\/span><\/span><\/div>\n
care. Hospitals, physicians and other health care providers are <\/o:p><\/span><\/span><\/div>\n
members of the network. The managed care plan can be public or <\/o:p><\/span><\/span><\/div>\n
private. <\/o:p><\/span><\/span><\/div>\n

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Q: Are there any benefits to managed care? <\/b><\/o:p><\/span><\/span><\/div>\n

<\/span><\/span><\/div>\n
A: Yes. Managed care plans can provide you with the following:<\/span><\/span><\/div>\n
\u2022 Help coordinating your care <\/o:p><\/span><\/span><\/div>\n
\u2022 Help finding primary care doctors and specialists <\/o:p><\/span><\/span><\/div>\n
\u2022 Help finding a pharmacy <\/o:p><\/span><\/span><\/div>\n
\u2022 Ongoing referrals to specialists <\/o:p><\/span><\/span><\/div>\n
\u2022 Telephone advice nurses <\/o:p><\/span><\/span><\/div>\n
\u2022 Customer service centers <\/o:p><\/span><\/span><\/div>\n
\u2022 Support groups <\/o:p><\/span><\/span><\/div>\n
\u2022 Health education programs to: <\/o:p><\/span><\/span><\/div>\n
o Quit smoking <\/o:p><\/span><\/span><\/div>\n
o Prevent and deal with drug and alcohol problems <\/o:p><\/span><\/span><\/div>\n
o Manage chronic pain <\/o:p><\/span><\/span><\/div>\n
o Eat well and exercise safely <\/o:p><\/span><\/span><\/div>\n

<\/span><\/div>\n
\u2022 Help getting to and from medical appointments (non-medical <\/o:p><\/span><\/span><\/div>\n
transportation) <\/o:p><\/span><\/span><\/div>\n

<\/span><\/div>\n
Q: If I\u2019m in managed care, can I keep the same doctors I have <\/o:p><\/b><\/span><\/span><\/div>\n
now? <\/b><\/o:p><\/span><\/span><\/div>\n

<\/span><\/div>\n
A: Ordinarily, your doctor must be part of the managed care network. <\/o:p><\/span><\/span><\/div>\n
However, if you now have a doctor who is not part of the managed <\/o:p><\/span><\/span><\/div>\n
care network, you can keep that doctor; but only if the doctor is both <\/o:p><\/span><\/span><\/div>\n
willing to keep seeing you and willing to accept the managed care <\/o:p><\/span><\/span><\/div>\n
network\u2019s payment rate or the Medi-Cal fee-for-service rate, <\/o:p><\/span><\/span><\/div>\n
whichever is higher. The doctor becomes a part of the managed care <\/o:p><\/span><\/span><\/div>\n
network just for purposes of caring for you. The doctor will have <\/o:p><\/span><\/span><\/div>\n
access to network providers for purposes of referrals, etc. <\/o:p><\/span><\/span><\/div>\n

<\/span><\/div>\n
Q: If I don’t already have doctors I like, will the health plan <\/o:p><\/b><\/span><\/span><\/div>\n
provide ones who know about my disability?<\/b>  <\/o:p><\/span><\/span><\/div>\n

<\/span><\/div>\n
A: The Medi-Cal managed care plan can help you find a doctor’s <\/o:p><\/span><\/span><\/div>\n
office that will meet your special needs. Your doctor and the health <\/o:p><\/span><\/span><\/div>\n
plan will be responsible for helping to coordinate your care. This <\/o:p><\/span><\/span><\/div>\n
includes helping you find the specialists you need. In addition, the <\/o:p><\/span><\/span><\/div>\n
managed care plan has telephone advice nurses to answer your <\/o:p><\/span><\/span><\/div>\n
health questions and customer service call centers to answer <\/o:p><\/span><\/span><\/div>\n
questions about your benefits. <\/o:p><\/span><\/span><\/div>\n

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Q: What if I don’t like managed care \u2013 can I get out? <\/b><\/o:p><\/span><\/span><\/div>\n

<\/span><\/div>\n
A: No. However, if you have a \u201ccomplex medical condition\u201d the <\/o:p><\/span><\/span><\/div>\n
managed care plan must provide continuous care with your current <\/o:p><\/span><\/span><\/div>\n
provider for up to one year after you enroll in the managed care plan. <\/o:p><\/span><\/span><\/div>\n
This is true whether or not the provider is willing to accept the <\/o:p><\/span><\/span><\/div>\n
managed care network\u2019s payment rate. The state is finalizing <\/o:p><\/span><\/span><\/div>\n
requirements for this \u201cexceptions process.\u201d <\/o:p><\/span><\/span><\/div>\n

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Q: I live in a rural county without any Medi-Cal managed care <\/o:p><\/b><\/span><\/span><\/div>\n
plans. Will I have to enroll in a managed care plan? <\/b><\/o:p><\/span><\/span><\/div>\n

<\/span><\/div>\n
A: No. <\/o:p><\/span><\/span><\/div>\n

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Q: How will I know what to do to enroll? <\/b><\/o:p><\/span><\/span><\/div>\n

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A: You should be getting letters and phone calls beginning about 90 <\/o:p><\/span><\/span><\/div>\n
days before you are required to enroll. The letters and phone calls <\/o:p><\/span><\/span><\/div>\n
will explain the steps you need to take and the options for managed <\/o:p><\/span><\/span><\/div>\n
care providers in your area. <\/o:p><\/span><\/span><\/div>\n

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Q: I don\u2019t have to enroll in managed care but I want to. Is it <\/o:p><\/b><\/span><\/span><\/div>\n
possible for me to enroll voluntarily? <\/b><\/o:p><\/span><\/span><\/div>\n

<\/span><\/div>\n
A: Yes, as long as your county has at least one managed care network <\/o:p><\/span><\/span><\/div>\n
that accepts Medi-Cal. <\/o:p><\/span><\/span><\/div>\n

<\/span><\/div>\n
Q: How can I find out more about the managed care plans in my <\/o:p><\/b><\/span><\/span><\/div>\n
area and pick the best one for me? <\/b><\/o:p><\/span><\/span><\/div>\n

<\/span><\/div>\n
A: You can find information about Medi-Cal managed care on the <\/o:p><\/span><\/span><\/div>\n
Health Care Options (California Department of Health Care Services) <\/o:p><\/span><\/span><\/div>\n
website: http:\/\/www.healthcareoptions.dhcs.ca.gov\/HCOCSP\/Home\/<\/a>. <\/o:p><\/span><\/span><\/div>\n

You can also call Health Care Options at: 1-800-430-4263. <\/span><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Many people with disabilities receive medical care, including durable medical equipment and medical supplies, through California’s Medi-Cal system. California is rolling out Mandatory Managed Care for people with disabilities and seniors. The questions and answers below outline who is affected and explain the basics regarding the transition. A big thank you to Disability Rights California for…<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[],"tags":[24],"class_list":["post-170","post","type-post","status-publish","format-standard","hentry","tag-insurance"],"_links":{"self":[{"href":"https:\/\/abilitytools.org\/blog\/wp-json\/wp\/v2\/posts\/170","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/abilitytools.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/abilitytools.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/abilitytools.org\/blog\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/abilitytools.org\/blog\/wp-json\/wp\/v2\/comments?post=170"}],"version-history":[{"count":0,"href":"https:\/\/abilitytools.org\/blog\/wp-json\/wp\/v2\/posts\/170\/revisions"}],"wp:attachment":[{"href":"https:\/\/abilitytools.org\/blog\/wp-json\/wp\/v2\/media?parent=170"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/abilitytools.org\/blog\/wp-json\/wp\/v2\/categories?post=170"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/abilitytools.org\/blog\/wp-json\/wp\/v2\/tags?post=170"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}