Managed care health plan transition

The purpose of All Plan Letter (APL) 23-018 is to provide guidance to all Medi-Cal Managed Care (Medi-Cal) health plans (MCPs) regarding the 2024 MCP transition effective January 1, 2024. The 2024 Managed Care Plan Transition Policy Guide (Policy Guide) establishes and details the requirements for the implementation of the 2024 MCP transition.

Background

The Department of Health Care Services (DHCS) contracts with MCPs to provide Medi-Cal services to its members. Effective January 1, 2024, DHCS is embarking on new relationships with MCPs to redefine how care is delivered across the state. DHCS’ top priority is to ensure managed care members have access to MCPs that provide timely and high-quality care, and that MCPs are focused on delivering on the state’s health system transformation goals. Those goals are the focus of the California Advancing and Innovating Medi-Cal (CalAIM) initiative, namely, to drive quality of care improvements; streamline and reduce complexity; and build on equity-focused, data-driven, and whole person care approaches. MCPs will be held to new standards of care and greater accountability, helping to ensure members have the care and support they need to live healthier, more fulfilling lives.

The Policy Guide governs MCP-to-MCP member transitions prompted by county-driven MCP model changes, changes to commercial MCP contracting, and a new direct contract with Kaiser Permanente. These three changes will drive member transitions from MCPs exiting a given county service area to other MCPs that will continue to operate in the county service area, or to MCPs newly entering the county service area. The Policy Guide outlines policies and contains DHCS’ operational requirements and guidelines for MCPs in facilitating the transition of those members leading up to and during the January 2024 MCP transition.

DHCS will confirm MCP readiness before the transition to ensure achievement of these goals. Furthermore, as outlined in the Policy Guide, MCPs will be required to engage in specific continuity of care and member support activities for incoming members, and other activities as assigned by DHCS and described in the Policy Guide, in advance of the transition and January 1, 2024, enrollment effective date.

Effective January 1, 2024, Anthem Blue Cross (Anthem) will exit 14 counties listed here: Alameda, Butte, Colusa, Contra, Costa Glenn, Mariposa, Nevada, Placer, Plumas, San Benito, Sierra, Sutter, Tehama, and Yuba.

Anthem will continue to offer Medicaid services in the following counties: Alpine, Amador, Calaveras, El Dorado, Fresno, Inyo, Kings, Los Angeles, Madera, Mono, Sacramento, San Francisco, Santa Clara, Tulare and Tuolumne.

In addition, effective January 1, 2024, Anthem will serve Kern county.

We are here to help

If you have questions or concerns about these changes, use the following resources:

• Medi-Cal Customer Care Center: 800-407-4627 (outside L.A. County)
• Medi-Cal Customer Care Center: 888-285-7801 (inside L.A. County)
• DHCS website: https://dhcs.ca.gov/Pages/MCP-Transition.aspx
• DHCS 2024 Medi-Cal Managed Care Transition Policy Guide: https://dhcs.ca.gov/Managed_Care_Plan_Transition_Policy_Guide.pdf

For additional information on APL 23-018, providers can visit the DHCS website at https://dhcs.ca.gov/formsandpubs/Pages/AllPlanLetters.aspx