AHF started their ACA Workshop with opening remarks from Alliance Healthcare Foundation's Executive Director Nancy Sasaki. Program Officer Sylvia Barron introduced the first presenter, Robin Hodgkin, Director of Imperial County Health Department. About the Event: To help those in Imperial County prepare for how the Affordable Care Act will impact work the community, Alliance Healthcare Foundation hosted a workshop on Sept. 11, 2013 at the San Diego Gas & Electric Renewable Energy Resource Center in Imperial County. In this workshop, we explored Covered California enrollment with an overview of multiple health plans and eligibility, discussed the community clinic perspective, and considered its potential impact on the underserved in Imperial County. This workshop was free and included a healthy lunch for all attendees. Watch the complete event here: http://www.youtube.com/playlist?list=PL-CwI2rkvFSV1_XYs45kGqdJj_R-jfXHP

1. An Overview of
Healthcare Changes in
Imperial County
Robin Hodgkin, MPA
Director of the Imperial County Public Health Department

3. Affordable Care Act
Medi-Cal Managed Care
Triple Aim
Accountable Care Organization
Mental Health Parity Act
Meaningful Use
Healthcare Information
Portability And Accountability Act
Clinical Pathways
Public Health Accreditation
Evidence Based Practice
Mental Health Services Act

4. Two Changes Impacting
Imperial County Residents Now
Medi-Cal Managed Care
Affordable Care Act

5. Medi-Cal Managed Care

6.  30 Counties with approximately 90% of Medi-Cal
recipients are already in Managed Care
 State requiring remaining 28 counties (all rural)
transition by the end of 2013
 Imperial County to implement: November 1, 2013
Medi-Cal Managed Care

7. Managed Care
An organized system of healthcare across the spectrum
of healthcare providers in a community that is
coordinated and administered by a Health Plan

8.  Medical Home
 Every member assigned a primary care home/PCP
 Case management and Coordination of Care
 Emphasis on prevention and wellness
 Focus on keeping medical services in county as appropriate
 Health plans can offer more resources
 Nurse advice lines
 Transportation assistance
 Help getting appointments with specialists
 Health Education (e.g. chronic care classes)
 Quality Improvement Programs
 Grievance systems
 Threshold languages for health plans
 Appropriate reading level of member materials
Differences Between Fee for Service and
Medi-Cal Managed Care

9.  Public Reporting
 Healthcare Effectiveness Data and information Set (HEDIS)/Quality and
Outcomes Data
 Financial Data
 Retention Data
 Designed to assist the member with navigation, decision making and
grievances
 Health Care Options (HCO)
 Office of the Ombudsman, DMHC
More Differences……

10. Aid Category Count %
Aged 7,100 13.5%
Disabled 7,674 14.6%
Families (& Child) 35,744 67.9%
Other 2,093 4.0%
Total 52,611 100.0%
Imperial County Medi-Cal Eligible
Source: DHCS

11. Imperial County Health Leadership Forum:
 Imperial County Board of Supervisors
 Imperial County Department of Public Health
 El Centro Regional Medical Center
 Pioneers Memorial Health Care District
 Imperial County Medical Society
 Clinicas de Salud del Pueblo
 Imperial County Department of Social Services
 Imperial County Department of Behavioral Health
Oversight of the Managed Care Transition in
Imperial County

12. Medi-Cal Managed Care System in
Imperial County
Two-Plan Model
 Consists of a Local Initiative Health Plan and a competing
commercial Health Plan
 Both Health Plans must meet federal and state requirements
before serving Medi-Cal beneficiaries.
 The Local Initiative Health Plan also works with the healthcare
safety net to develop and implement additional initiatives and
programs to meet the unique needs of our community. There
is also local oversight and participation in quality
improvement.

13. Medi-Cal Managed Care System in
Imperial County
Our Two Health Plans are –
Local Health Initiative Health Plan:
California Health and Wellness
Commercial Health Plan:
Molina

14. Medi-Cal Managed Care System in
Imperial County
Health Plan Selection
 Medi-Cal beneficiaries have the right to choose a Health
Plan
 If a choice is not made, the beneficiary will be randomly
assigned to a Health Plan
 Initial Health Plan section opportunity began September
1, 2013 and will end October 25, 2013.
 Medi-Cal beneficiary can change their Health Plan
selection at any time – the change may take up to 45 days
to process.
 Health Care Options, a state funded organization, is
tasked with helping beneficiaries select their Health Plan.

15. The Affordable Care Act

16. Affordable Care Act
 Signed into law in March 2010
 Designed to be incrementally implemented over
several years
 Supreme Court decision rendered in March 2012
 Upheld the Individual Mandate
 Gave states more flexibility in mandate to expand Medicaid
(Medi-Cal) coverage

17. Goals of Affordable Care Act
 Expand access to health insurance coverage
 Improve Coverage Terms
 Improve Healthcare
 Improve Health

18. Not Included in the Affordable Care Act
 Public Option
 Bi-Partisan Consensus
 Tort Reform
 Insurance Rate Controls
 Undocumented Immigrants

19. Affordable Care Act - Effective 2011
 Dependent coverage up to age 26
 Preventive services covered at no cost
 No annual limits on essential benefits
 No lifetime limits
 Cancellations prohibited
 No pre-existing condition exclusions for children
(under 19)
 Required appeal process for any denial
 Long-term care program

20. Affordable Care Act - Effective 2014
 Essential Benefits plan effective
 Expansion of Medi-Cal
 Insurance Exchange operational
 Employers (with more than 50 FTEs) required to
provide health insurance - Delayed
 Individuals required to have health insurance
 Free Choice Voucher to employees making less than
400% of poverty level
 Health plans required to report on quality of care
 Pre-existing condition exclusions are prohibited for all

21.  Newly eligible Medi-Cal beneficiaries could be enrolled
from 2014-2018
20,554 estimated
 0-17 2,498
 18-64 17,788
 Over 65 268
 Change in eligibility requirements
Increase in eligibility income up to 133% FPL
Single childless adults
No asset test
Affordable Care Act Medi-Cal Expansion

22. What to Expect and What to Do
 The changes will continue to change
 Some of the changes will remain controversial
 Some of the changes will happen very quickly and
some with unfold over the next 2-3 years
 Become involved and informed
 Know who to contact about what

23. Contact List for Medi-Cal Managed Care
 Health Care Options
 www.healthcareoptions.dhcs.ca.gov
 1-800-430-4263
 California Health and Wellness
 www.cahealthwellness.com
 (877) 658-0305
 Molina
 www.molinahealthcare.com
 (888) 665-4621
 Medi-Cal Ombudsman:
 MMCDOmbudsmanOffice@dhcs.ca.gov
 1-888-452-8609