DHCS has sought a number of waivers from CMS to change the nature of the Medi-Cal program moving from fee for service to enrolling a larger percentage of enrollees into Medi-Cal managed care programs either to County Operated Health System , such as in the county of San Mateo, or to a two plan model that offers two private health plans, often Anthem and Health Net within a geographic area. Medi-Cal already has more than 50 % of its beneficiaries in a managed care model but since last year has begin to transition more complex patients into managed care models. Last year saw the transition of most Seniors and Persons with Disabilities ( SPDs). In June of 2013, subject to CMS approval, Medi-Cal will transition dual eligibles those with both Medi-Cal and Medicare eligibility. That transition will occur in the beneficiaries month of birth in the following eight counties; Alameda, San Mateo, Santa Clara, Los Angeles, Orange, San Diego, Riverside and San Bernardino. Medi-Cal enrollment in a managed care plan will be mandatory but a beneficiary could still opt for the Medicare portion of their coverage and stay in Fee for service or a Medicare Advantage Plan. 

This will be important for radiology groups to monitor if they are in an impacted county as these patients might migrate to other plans or payers than the Medicare fee for service as in the past. These dual eligibles can opt out of managed care for the Medicare portion of their benefits but not for the Medi-Cal portion. This means that if such a patient opts out for Medicare they could stay in the fee for service program or stay in a Medicare Advantage Plan. The specific timing of this transition will be finalized once CMS provides approval for the California pilot program.

Invitation From the Eastern Radiology Society  

We are passing along a letter of invitation from Dr. Paul Schulman regarding the annual meeting of the Eastern Radiological Society. Click this link to see his letter.

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