By 2014, the Healthy Families insurance program will be fully integrated into Medi-Cal. This change will affect approximately 875,000 children currently in the Healthy Families Program.
Children will not lose health coverage.
• While the move may require some families to choose a new health plan or change their doctor or dentist, children currently in Healthy Families will continue to have comprehensive health insurance, with no gap in coverage.
• Medi-Cal coverage includes all the benefits of Healthy Families coverage, as well as better mental health benefits.
• The cost of premiums will not increase, and families with incomes determined to be at or below 150 percent of the federal poverty line will no longer be charged premiums once they move to Medi-Cal.
What this means for your district:
Healthy Families recipients will begin to move into Medi-Cal in 2012. Because of the influx of new enrollees into Medi-Cal, your district’s Medi-Cal percentage (the percentage of your student body who receives Medi-Cal) will likely increase. Your Medi-Cal percentage is used to help determine the amount of reimbursement your district receives through the Medi-Cal Administrative Activities (MAA) Program – the higher the Medi-Cal percentage, the higher your reimbursements.
Additionally, if any of these students on Healthy Families are receiving direct charge (LEA) services, your district may begin to bill for these services once the student has been enrolled in Medi-Cal. The additional billing opportunities will translate into additional reimbursement for your district.
MBT is here to help.
As always, MBT is dedicated to optimizing your district’s Medi-Cal claiming programs and ensuring the highest levels of reimbursement are returned to you and your students. If you have any questions and the Healthy Families/Medi-Cal transition, please contact David Bacci, Director of Client Services.