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A federal waiver granted under Section 1115(a) of the Social Security Act permits mandatory enrollment of Medi-Cal only Seniors and Persons with Disabilities into Medi-Cal managed care.  The Waiver allows the Department of Health Care Services to achieve care coordination, better manage chronic conditions, and improve health outcomes.  Mandatory enrollment begins June 2011.

Medi-Cal Managed Care Transition FAQ: Who We Are

MMCD Transition: Seniors & Persons with Disabilities Frequently Asked Questions (FAQs)

Q: Does DHCS have any information out there for providers on the SPD transition?

A: Yes. DHCS developed a website specifically for this transition. The link to the website is

Q: What sort of information is provided on the Department’s website?

A: The MMCD SPD website includes important information for Medi-Cal members, providers and health plans. It includes an informative FAQ section that will answer a lot of general questions for providers.

Q: Who can providers direct their questions or comments for the Department to?

A: Providers can email the Department at or call the Ombudsman at


Q: Where is there a listing of the plans and counties affected by mandatory enrollment?

A: This information is available on the SPD transition website at

Q: Will CCS continue to be carved out in counties such as Napa, Solano, and Sonoma?

A: According to DHCS, carve-outs are still a topic of internal discussion and no decision has been made at this time.

Q: Will providers be forced to contract with the health plans in order to continue providing service to SPDs?

A: DHCS recognizes that providers cannot be forced to contract with health plans. Providers may continue servicing their SPDs even if they are not contracted with a particular health plan. The topic of out-of-network providers was addressed recently in statute (SB208). Welfare & Institutions code 14181 has been amended to read:

“…(13) Ensure that managed care health plans participating in the demonstration project provide access to out-of-network providers for new individual members enrolled under this section who have an ongoing relationship with a provider if the provider will accept the health plan’s rate for the service offered, or the applicable Medi-Cal fee-for-service rate, whichever is higher, and the health plan determines that the provider meets applicable professional standards and has no disqualifying quality of care issues…”

Q: How can CAMPS members become more involved with this transition?

A: CAMPS has a Reimbursement Subcommittee that is actively working with the Department on this transition. They meet at least once a month via conference call. Please contact Benjamin Ichimaru at or Dave Fein at if you are interested in participating in this subcommittee.

Medi-Cal Managed Care Transition FAQ: Who We Are
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