APL 21-015 Mandatory Managed Care Enrollment (MMCE) Transition Phase II
| Date: | November 2, 2022 |
| To: | HPSJ Primary Care Providers, Specialists, Hospitals and Facilities |
| From: | Health Plan of San Joaquin (HPSJ) |
| Subject: | APL 21-015 Mandatory Managed Care Enrollment (MMCE) Transition Phase II |
| Business: | Medi-Cal Managed Care |
As part of CalAIM, mandatory managed care enrollment (MMCE) aims to enhance coordination of care, increase standardization, and reduce complexity by standardizing which members will be enrolled in health plans like HPSJ from Medi-Cal Fee-for-Service (FFS).
Effective 01/01/23 the following populations will transition from Medi-Cal FFS to managed care:
- Full dual individuals, except share of cost or restricted scope
- Dual and non-dual individuals receiving Long Term Care (LTC) services (including those with a share of cost)
- Individuals who were subject to transition as part of Phase I but did not transition for various reasons. This population includes dual and non-dual beneficiaries.
Member outreach will be as follows:
- DHCS will mail MMCE 30 and 60-Day Notices to members by 11/1/2022 and 12/1/2022
- If a member is part of a Medi-Cal matching plan policy, they will receive notices that includes the name of the managed care plan the beneficiary will be assigned to if they do not choose a managed care plan by the default date. They will receive choice packets in in November 2022.
- Members that are part of the Medi-Cal matching plan policy will receive notices with their managed care plan information based on their Medicare Advantage Plan enrollment.
- DHCS’ Health Care Options (HCO) will also be conducting an outbound call campaign to impacted members to educate them on upcoming changes.
A copy of the related APL 21-015 can be found at:
A fact sheet on Medi-Cal Managed Care Changes in January 2023 for Dual Eligible Beneficiaries can be found on the DHCS webpage:
You may also contact our Provider Services Department with any questions or concerns, Monday through Friday, 8:00 am to 5:00 pm, at 1-888-936-PLAN (7526), TDD/TYY 711or visit https://www.hpsj-mvhp.org/alerts/ for online access to the documents shared. The most recent information about Health Plan of San Joaquin and our services is always available on our website https://www.hpsj-mvhp.org/.