Healthy Families Program Transition to Medi-Cal: Monitoring Report and Summary Published for Phases 1C and 2

Assembly Bill 1494 requires the California Department of Health Care Services (DHCS) to submit monthly reports on the Healthy Families Program transition to Medi-Cal. On May 15, 2013 the fourth report, on Phases 1C and 2 of the transition, was published.

Included in the April Monitoring Report and Summary is data related to: maintaining coverage for transition children, the appropriate enrollment of new enrollees, timely access to care, continuity of care, provider capacity, and consumer satisfaction under each phase, consistent with Medicaid requirements.

Key findings, detailed on page 4 and 5 of the report, include:

  1. A total of 270,308 children successfully transitioned into Medi-Cal under Phase 1C (April) & Phase 2 (section 1.1).
  2. 47,136 children undergoing annual renewal in April (section 1.3):
    1. 15,339 children determined eligible at annual renewal for Optional Targeted Low Income Children’s Program (OTLICP)*
    2. 1,619 children determined ineligible at annual renewal for OTLICP
    3. 30,178 cases pending completion of an annual renewal determination
  3. 95.56 percent of children were assigned to a primary care provider (section 2.4) and 100 percent of children remained in the same health plan (section 2.2) in Phase 1C and Phase 2.
  4. Approximately a dozen cases have been brought to the attention of DHCS regarding access to autism services for children transitioning on or after April 1, 2013, specifically applied behavioral analysis (ABA) and/or applied behavioral therapy (ABT) services (section 2.6).
  5. 52 percent of enrolled dental service office locations are accepting new patients and are listed on the Provider Referral list (section 3.3.2).
  6. Of the 24 dental grievances reported, only three were related to a transitioned child under the Denti-Cal program (section 3.5.3).
  7. All 9,178 beneficiary requests for dental provider referrals were successful (section 3.3.4).
  8. In the first quarter Denti-Cal has received over 98,000 claim submissions and paid out in excess of $10 million in claims for children who have transitioned from Healthy Families through April 30, 2013 (section 3.11).

* Children transitioning from the Healthy Families Program will be moved into Medi-Cal’s new Optional Targeted Low Income Children’s Program (OTLICP). This program covers children with incomes up to and including 250% of the federal poverty level.


Read More

Read the Monitoring Report and Summary, Phase 1C and Phase 2 (April 1-30, 3013)…

View historical DHCS Monitoring Report and Summary reports…

Learn more about the Healthy Families Program Transition to Medi-Cal in our Issue Analysis section…