California’s Medi-Cal program expanded under the ACA to a 12 million-person program, with approximately one out of every three Californians insured through Medi-Cal. Simultaneously, the state moved the Healthy Families population, dual eligibles and most of the Medi-Cal population into Medi-Cal managed care. On this page, CAFP members can find information on Medi-Cal/Medicare Payment Parity, the Healthy Families transition, the Coordinated Care Initiative for Dual Eligibles and the Medi-Cal expansion.
Medi-Cal/Medicare Payment Parity
Under the ACA, Medicaid fee-for-service and managed care payments equaled Medicare payments for primary care physicians doing primary care services in 2013 and 2014. The Department of Health Care Services (DHCS)’s implementation of this policy was troubled and payments were delayed. CAFP advocates for family physicians and their patients in fair payment for Medi-Cal services and access to providers.
Check out AAFP's fact sheet on the regulations.
Healthy Families Transition
Pursuant to Assembly Bill (AB) 1494, all Healthy Families Program (HFP) enrollees transitioned to Medi-Cal as targeted low-income Medicaid children, beginning January 1, 2013. The transition of approximately 875,000 HFP enrollees was implemented in phases over the course of two years. DHCS has said that at each phase it would issue an implementation plan that includes information on health and dental plan network adequacy, continuity of care, eligibility and enrollment requirements, consumer protections and family notifications.
Dual Eligibles Transition
In January 2012, Governor Brown announced the Coordinated Care Initiative (CCI), with the goals of enhancing health outcomes and beneficiary satisfaction for low-income seniors and persons with disabilities (SPDs), while achieving substantial savings from rebalancing service delivery away from institutional care and into the home and community.