Page Content. Medi-Cal Enrollment Update This presentation includes monthly counts of Medi-Cal applications, as well as new enrollments categorized by basic demographic and administrative characteristics. Medi-Cal Monthly Eligible Fast Facts Medi-Cal at a Glance A condensed representation of Fast Facts data, Medi-Cal at a Glance is a two-page snapshot of individuals who enrolled in Medi-Cal during the most recent reportable month, categorized by basic demographic and administrative characteristics.
Enrollment Dual Status Enrollment by Delivery System and Aid Code Dataset includes statewide Medi-Cal enrollment counts by month, aid code, and delivery system, from January to the most recent reportable month.
Enrollment by Delivery System and Aid Code Enrollment by Delivery System and Health Plan Dataset includes monthly enrollment counts by county, delivery system FFS or managed care , and health plan, from January to the most recent reportable month. Certified eligibles are those beneficiaries deemed qualified for Medi-Cal by a valid eligibility determination, and who have enrolled into the program.
This classification excludes beneficiaries who have not met a monthly share-of-cost obligation. The certified eligible counts presented in this document are considered preliminary and are subject to change. While the statewide average is one-third, some counties have more than half of their residents enrolled.
This statistical brief presents data on the proportion of residents enrolled in Medi-Cal by county and age group, and also presents the proportion of each county's children ages enrolled in the program, by county. Between December and December , the program grew from 7. Plan participation in the Dual Demonstration is limited to Medi-Cal plans already serving the area. Participating plans contract with other entities to provide some services, such as behavioral health and In-Home Supportive Services, although the goal is that dually eligible beneficiaries receive all their care in a single, organized delivery system.
To accomplish this, plans must organize providers who have not previously contracted with managed care plans or who have not previously provided services to Medicare beneficiaries. Under the Dual Demonstration, plans are also subject to specific and detailed DHCS and CMS contract requirements to maintain continuity of care, perform health risk assessments, and use person-centered, interdisciplinary care management teams.
Enrollment in the Dual Demonstration is voluntary; as of December 1, , , dually eligible enrollees — about one-quarter of the eligible population — were enrolled in it. The goal of the EDIP is to improve the timeliness, accuracy, and completeness of encounter data reported by managed care plans, to improve rate-setting and managed care monitoring, and to prepare for value-based purchasing.
As part of the project, DHCS develops performance metrics and works with managed care plans to address their data collection and reporting deficiencies. This collaborative effort on data and metrics is critical in connection with performance reporting and will be foundational to value-based purchasing in the future. To increase transparency regarding the quality of managed care plans, DHCS has created a Managed Care Performance Dashboard that provides plan-reported data on a variety of measures to help DHCS and other stakeholders examine and understand managed care activity and performance at the state level, by managed care model, and at the individual plan level.
The dashboard contains metrics related to enrollment, enrollee health care utilization, appeals and grievances, and quality of care. The dashboard stratifies the plan-reported data by beneficiary population. Provider payment rates and participation. Managed care plans are required to maintain adequate provider networks and capacity to ensure access to care for their members. However, CMS limited application of the latter requirement to FFS rate-setting, stating that standards for capitation payment rates are set in the June 1, proposed rule on Medicaid managed care.
Data from a survey of Medi-Cal enrollees show that the vast majority of beneficiaries found it easy to find a provider who accepted Medi-Cal, but almost 1 in 5 enrollees had difficulty. Fewer than half of Medi-Cal enrollees said it was easy to find a specialist or mental health provider who accepted Medi-Cal; enrollees in fair or poor health were particularly likely to report difficulty finding specialists.
Linguistic and cultural gaps in access. Another challenge in Medi-Cal is the lack of linguistic and cultural concordance between the current provider workforce and the low-income population in California. Rural areas. While access to care is generally sufficient in most urban areas, securing access to care in rural areas is more challenging for publicly and privately insured patients alike.
FQHCs, rural health centers RHCs , and other health clinics form the backbone of the ambulatory care delivery system serving low-income populations in rural counties, and these safety net provider play an increasingly critical role in Medi-Cal managed care networks in rural as well as other areas of the state.
Stakeholder engagement. Robust stakeholder engagement is needed to support smooth managed care transitions. For example, in the Dual Demonstration, the state held extensive webinars, workshops, and stakeholder meetings, which state officials said resulted in better and more effective outreach. Data issues. In the SPD transition, inaccurate enrollee contact information, privacy rules that prevented plans and providers from accessing beneficiary medical records, and other data problems made timely implementation of care coordination challenging for Medi-Cal plans.
The state was able to improve its data-sharing processes in the Dual Demonstration to give plans more time to contact incoming enrollees and prepare for their needs. Still, contacting beneficiaries to complete health assessments to support care management remains a challenge for plans, particularly in the case of individuals newly eligible for Medi-Cal and people without stable addresses.
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