Ensuring a Seamless Transition to Managed Care for Medi-Cal Members with Complex Needs

In recent years, California has implemented its California Advancing and Innovating Medi-Cal (CalAIM) initiative which aims to transform Medi-Cal into a more integrated and standardized health care system for members with complex needs. California has partnered with Aurrera Health Group to support its CalAIM work and help transition members receiving institutional Long-Term Care (LTC) from fee-for-service to Medi-Cal managed care. This transition, referred to as the LTC Carve-In, includes Medi-Cal members receiving institutional LTC in both Subacute and Intermediate Care Facilities (ICF/DD) who transitioned to managed care on January 1, 2024. The LTC Carve-In aims to standardize institutional LTC covered under managed care statewide and advance a more consistent and cohesive delivery system. The strategy focuses on increasing access to comprehensive care coordination, care management, and the wide array of services required by members in institutional settings. For example, members with intellectual or developmental disabilities residing in an ICF/DD may require skilled nursing assistance and 24-hour personal care to support activities of daily living, as well as services and treatments such as adapted feeding techniques and psychiatric evaluations. Ensuring a seamless transition to managed care for these and other Medi-Cal members in LTC institutional settings is critical to preventing disruptions in care. 

Aurrera Health’s Role in Supporting Stakeholder Readiness 

In 2023, Aurrera Health Group supported DHCS and the Department of Development Services (DDS) during the LTC care delivery transition by facilitating a series of educational webinars, trainings, and office hours for stakeholders across the LTC landscape, including ICF/DDs, Subacute Care Facilities, and Pediatric Subacute Care Facilities. Aurrera Health Group also developed policy and implementation resources for providers, managed care plans, and Medi-Cal members. These resources include: 

• A stakeholder inquiry inbox; 

• Frequently asked question documents and fact sheets; and 

• Provider and payor liaison contact databases for stakeholders. 

The tailored resources addressed stakeholder questions and concerns and provided training related to changes to billing and payment operations, services authorization processes, contracting requirements, and care coordination best practices. Many of the resources to guide and assist DHCS, DDS, and the California LTC community to prepare for the 2024 transition are available to the public on the CalAIM Long-Term Care Carve-In Transition webpage.  

Next Steps 

Aurrera Health Group will continue to support DHCS and DDS to bring LTC providers, members, and services into Medi-Cal managed care in 2024 through post-implementation monitoring support, stakeholder resolution dispute management, and continued community engagement.  Is your state considering strategies to transition complex patient populations to more integrated care models? Aurrera Health Group has the tools to provide strategic guidance, communication resource development, and stakeholder education necessary to ensure members receive person-centered care designed to improve individual outcomes and population health. If you are interested in learning more about our services and approach, please reach out to Kristal Vardaman. 

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Authors

Brendan Finn [Senior Policy Consultant]