CAL MEDl-CAL MEDICONNECT MANAGED (CMC) LONG TERM …

Medi-Cal Managed Care Plans Mandatory or Voluntary Enrollment

by Medi-Cal Aid Codes

Updated: January 8, 2019

COUNTY ORGANIZED HEALTH SYSTEMS (COHS)

SAN BENITO (SB)

08 Del Norte 12 Humboldt 17 Lake 18 Lassen 21 Marin 23 Mendocino 24 Merced 25 Modoc 28 Napa 27 Monterey 30 Orange 41 San Mateo 40 San Luis Obispo 42 Santa Barbara 44 Santa Cruz 45 Shasta 47 Siskiyou 48 Solano 49 Sonoma 53 Trinity 56 Ventura 57 Yolo

35 San Benito

Abbreviation Key:

M Mandatory,

V VMVoluVnMotaalunrynd,ta

atroyDry Voluntary for Duals/Mandatory for NDonV-Doluuanltsa,r

y fPorMDaunaldsa/MtoarnydfaotrorNyafopraN, Sono-lDanuaol,s

YPoloMoannlyd,a

toNry/AforNNoat pina,MSaonlaangoe, dYoCloaroen.ly

COORDINATED CARE INITIATIVE GEOGRAPHIC MANAGED CARE (GMC) / REGIONAL /

COORDINATED CARE INITIATIVE (CCI*)

TWO PLAN / IMPERIAL

CAL MEDl-CAL CAL MEDICONNECT MEDI-CAL MANAGED LONG

(CMC*)

TERM SUPPORT & SERVICES

(MLTSS*)

01 Alameda 02 Alpine 03 Amador

29 Nevada 31 Placer 32 Plumas

19 Los Angeles

19 Los Angeles

MEDICONMNAENCATGED 30 Orange

33 Riverside

30 Orange 33 Riverside

04 Butte

33 Riverside

36 San Bernardino

36 San Bernardino

05 Calaveras 06 Colusa

34 Sacramento 36 San Bernardino

(CMC) 37 San Diego

41 San Mateo

LONG 37 San Diego

41 San Mateo

07 Contra Costa

37 San Diego

43 Santa Clara

43 Santa Clara

09 El Dorado 10 Fresno 11 Glenn

38 San Francisco 39 San Joaquin 43 Santa Clara

TERM

13 Imperial

46 Sierra

14 Inyo 15 Kern

50 Stanislaus 51 Sutter

SUPPORT

16 Kings

52 Tehama

19 Los Angeles 20 Madera

54 Tulare 55 Tuolumne

&

22 Mariposa

58 Yuba

26 Mono

SERVICES

(MLTSS)

N*oDte,uCoaolrsdinaotend lCyare(MInitieatidvei-(CCCIa), lC/aMl-Meeddi-ciconanercet (CeMlCig), aibndle)

Medi-Cal Managed Long Term Support & Services (MLTSS) are Duals only

(Medi-Cal Medicare eligible). For infowrmwawti.ocnalodnuaClsa.loifrogrnia's Dual Eligible

1

Population, visit the N/A not CalDuals website at: in Managed Care

Medi-Cal Managed Care Plans Mandatory or Voluntary Enrollment

by Medi-Cal Aid Codes

Updated: January 8, 2019

AID CODE

0A

0C

0D

RATE GROUP

Adult & Family OTLIC

N/A

N/A

PROGRAM / DESCRIPTION

COHS

Refugee Cash Assistance (RCA). Covers all eligible refugees during their first eight months in the United

States, including unaccompanied children who are not subject to the eight-month limitation. This

population is the same as aid code 01, except that they are exempt from grant reductions on behalf of the

Assistance Payments Demonstration Project/California Work Pays Demonstration Project.

M

Full Benefits. No Share of Cost. FFP: 100%

Access for Infants and Mothers (AIM) Infants enrolled in Healthy Families (HF) whose family's income is

200 to 300 percent of the FPL, born to a mother enrolled in AIM. The infant's enrollment in HF is based on

the mother's participation in AIM.

N/A

Healthy Family Only. No Medi-Cal. FFP: Enahnced 65% Title XXI

AIM Subscribers

Full Benefits. No Share of Cost. FFS Only. FFP: N/A

N/A

GMC / CCI CCI*

SB

REGIONAL TWO PLAN

//CMCMCC*

MMLLTTSSSS*

V

M

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

Adult & Medi-Cal Access Program (MCAP) Pregnant Women >213% = 322% FPL Managed Care

0E

Family

OTLIC Full Beneifts. No Share of Cost. FFP: 65/35 Fed/State Title XXI

M

V

M

V

V

AbMbrevMiaatniodnaKtoeryy:

M Mandatory,

V Voluntary,

D VoVluntVaorylufnotraDryuals/Mandatory for Non-Duals,

P

MaDndVaotolurynftoaryNfaopraD, uSaolsa/nMoa, nYdoalotoornylyfo,

r NNo/An-NDoutainls

MaPnagMeadnCdaarteo.ry for Napa, Solano, Yolo only

2

Note, Coordinated Care Initiative (CCI), Cal-Medi-connect (CMC), and Medi-Cal

Man*aDgeduLaonlgsTeormnSlyupp(oMrt &eSderiv-icCesa(Ml/LMTSSe)dariecDauarles onelyl(iMgeidbi-Cleal) Medicare eligible). For information on California's Dual Eligible Population, visit



the CalDuals website at: N/A not in Managed Care

Medi-Cal Managed Care Plans Mandatory or Voluntary Enrollment

by Medi-Cal Aid Codes

Updated: January 8, 2019

AID CODE

RATE GROUP

PROGRAM / DESCRIPTION

Breast and Cervical Cancer Treatment Program (BCCTP) Transitional coverage until the County makes a determination of Medi-Cal eligibility. Covers:

COHS

GMC / CCI

CCI*

SB REGIONAL /CMC MLTSS

TWO PLAN / CMC* MLTSS*

? BCCTP recipients formerly in aid code 0U, without satisfactory immigration status, who are no longer in

need of treatment, and/or have creditable health coverage and are not eligible for state-funded BCCTP.

? BCCTP recipients formerly in aid code 0V, without satisfactory immigration status, who have turned 65

years of age, have other health coverage, and/or are no longer in need of treatment and have exhausted

0L

BCCTP their 18-month (breast cancer) or 24-month (cervical cancer) time limit.

N/A N/A

N/A

N/A

N/A

? BCCTP recipients formerly in aid code 0X with creditable health coverage who have exhausted their 18

months (breast cancer) or 24 months (cervical cancer) of state eligibility.

? BCCTP recipients formerly in aid code 0Y, age 65 or older who have exhausted their 18 months (breast

cancer) or 24 months (cervical cancer) of state eligibility.

Restricted Benefits. No Share of Cost. FFP Under 50%

BCCTP? Accelerated Enrollment (AE). Provides temporary AE for full-scope, no Share of Cost Medi-Cal

for eligible females under age 65 who have been diagnosed with breast and/or cervical cancer. Limited to 2

0M BCCTP months.

N/A N/A

N/A

N/A

N/A

Full Benefits. No Share of Cost. Enhanced FFP 65% (Title XXI)

BCCTP ? AE. Provides temporary AE for full-scope, no Share of Cost Medi-Cal while an eligibility

determination is made for eligible females under age 65 without creditable health coverage who have been

0N

BCCTP diagnosed with breast and/or cervical cancer.

M

V

V

N/A

N/A

Full Benefits. No Share of Cost. Enhanced FFP 65% (Title XXI)

AbMbreMviaatniodnatKoeryy:

M Mandatory,

V Voluntary,

D VoVlunVtaorlyunfotrarDyuals/Mandatory for Non-Duals,

P

MDandVaotoluryntfaorryNfaopr aD,uSaolsla/Mnoa,nYdoalotoorynlfyo.

r NNo/An-NDoutailns

MPanaMgeadndCaatroer.y for Napa, Solano, Yolo only

3

Note, Coordinated Care Initiative (CCI), Cal-Medi-connect (CMC), and Medi-Cal

Ma*naDgeud aLolnsg ToernmlSyup(pMort e& dSeir-vCicesa(lM/LMTSeS)dairce Dauraels oenlyli(gMiebdi-lCea)l

MtheedCicaalDreueallisgiwbeleb).sitFewoarwti:nwfor.mcNaatilo/dnAuonanClsao.lioftorwrignniaw'sMwDua.aclnEalaigligdbleuePadoplsuCla.toaiornr,gevisit

Medi-Cal Managed Care Plans Mandatory or Voluntary Enrollment

by Medi-Cal Aid Codes

Updated: January 8, 2019

AID CODE

0P

RATE GROUP

BCCTP

PROGRAM / DESCRIPTION

BCCTP. Provides full-scope, no Share of Cost Medi-Cal for eligible females under age 65 who are diagnosed with breast and/or cervical cancer and are without creditable insurance coverage. They remain eligible while still in need of treatment and meet all other eligibility requirements.

COHS M

GMC / CCICCI*

SB

REGIONAL / TWO PLAN /

CCMMCC*

MMLLTTSSSS*

V

V

N/A

N/A

Full Benefits. No Share of Cost. Enhanced FFP 65% (Title XXI)

BCCTP ? High Cost Other Health Coverage. Provides payment of premiums, co-payments, deductibles

and coverage for non-covered cancer-related services for eligible all-age males and females, including

undocumented aliens, who have been diagnosed with breast and/or cervical cancer, if premiums, co-

0R BCCTP payments and deductibles are greater than $750. Breast cancer-related services covered for 18 months.

M

N/A

N/A

N/A

N/A

Cervical cancer-related services covered for 24 months.

Restricted Benefits. No Share of Cost. State Funded

BCCTP ?- Provides 18 months of breast cancer treatments and 24 months of cervical cancer treatments for eligible all-age males and females 65 years of age and older, regardless of citizenship, who have been diagnosed with breast and/or cervical cancer. Does not cover individuals with expensive, creditable

0T

BCCTP insurance. Breast cancer-related services covered for 18 months. Cervical cancer-related services covered M

N/A

N/A

N/A

N/A

for 24 months.

Restricted Benefits. No Share of Cost. State Funded.

BCCTP ? Undocumented Aliens. Provides emergency, pregnancy-related and Long Term Care (LTC)

services to females under age 65 with unsatisfactory immigration status who have been diagnosed with

breast and/or cervical cancer. Does not cover individuals with creditable insurance. Cancer treatment

0U

BCCTP services are 18 months (breast) and 24 months (cervical).

M

N/A

N/A

N/A

N/A

Restricted Benefits. No Share of Cost. FFP Under 50%

AbMbrevMiaatniodnaKtoeryy:

M Mandatory,

V Voluntary,

D VoVluntVaorylufnotraDryuals/Mandatory for Non-Duals,

P

MaDndVaotolurynftoaryNfaopraD, uSaolsa/nMoa, nYdoalotoornylyfo,

r NNo/An-NDoutainls

MaPnagMeadnCdaarteo.ry for Napa, Solano, Yolo only

4

Note, Coordinated Care Initiative (CCI), Cal-Medi-connect (CMC), and Medi-Cal

Mana*gDeduLoanlgsTeormnSluypp(oMrt &eSdervii-cCes a(MlL/TMSSe) adreicDauarlseonely l(Migedibi-Clael )

Medicare eligible). For information on California's Dual Eligible Population, visit

the CalDuals website at:

N/A not in Managed Care

Medi-Cal Managed Care Plans Mandatory or Voluntary Enrollment

by Medi-Cal Aid Codes

Updated: January 8, 2019

AIDAID CODE

RATE GROUP

PROGRAM I DESCRIPTION PROGRAM / DESCRIPTION

CODE

0V

N/A

Post ? BCCTP. Provides emergency, pregnancy-related, and LTC services for females under age 65 with unsatisfactory immigration status and without creditable health insurance coverage who have exhausted their 18 month (breast) or 24 month (cervical) period of cancer treatment coverage under aid code 0U. No cancer treatment. Continues as long as the woman is in need of treatment and, other than immigration, meets all other eligibility requirements.

COHS N/A

Restricted Benefits. No Share of Cost. FFP Under 50%.

BCCTP transitional coverage. Covers recipients formerly in aid code 0P who no longer meet federal

BCCTP requirements due to reaching age 65, are no longer in need of treatment for breast and/or cervical

cancer, or have obtained creditable health coverage. Recipients in aid code 0W will continue to receive

0W BCCTP transitional full-scope Medi-Cal services until the county completes an eligibility determination for other

M

Medi-Cal programs.

GMC GMC / CCI CCI*

SB

REGIONAL TWO PLAN

//CMCMCC*

MMLLTTSSSS*

/

N/A RENG/A IONNA/A L N/A

/

TWO

PLAN V

V

N/A

N/A

Full Benefits No Share of Cost FFP 50% BCCTP Transitional coverage. Covers recipients formerly in aid code 0U who do not have satisfactory

immigration status, have obtained creditable health coverage, still require treatment for breast and/or

cervical cancer and have not exhausted their 18 months (breast cancer) or 24 months (cervical cancer) of

coverage under State funded BCCTP. Recipients eligible only for transitional emergency, pregnancy-

0X

N/A related and State only LTC services, and co-pays, deductibles and/or non-covered breast and/or cervical

N/A

N/A

N/A

N/A

N/A

cancer and related services.

Restricted Benefits. No Share of Cost. FFP Under 50%

AbMbrevMiaatniodnaKtoeryy:

M Mandatory,

V Voluntary,

D

VoVluntVaorylufnotraDryuals/Mandatory for Non-Duals,

P

MaDndVaotolurynftoaryNfaopraD, uSaolsa/nMoa, nYdoalotoornylyfo,

r NNo/An-NDoutainls

MaPnagMeadnCdaarteo.ry for Napa, Solano, Yolo only

5

*Duals only (Medi-Cal/Medicare eligible) Note, Coordinated Care Initiative (CCI), Cal-Medi-connect (CMC), and Medi-Cal

Managed Long Term Support & Services (MLTSS) are Duals only (Medi-Cal

Medicare eligible). For information onwCwawli.fcoarnldiau'aslsD.ouragl Eligible Population, visit

the CalDuals website at: N/A not in Managed Care

Medi-Cal Managed Care Plans Mandatory or Voluntary Enrollment

by Medi-Cal Aid Codes

Updated: January 8, 2019

AID CODE

0Y

RATE GROUP

N/A

PROGRAM / DESCRIPTION

BCCTP Transitional coverage. Covers recipients formerly in aid code 0U who do not have satisfactory immigration status, have reached 65 years of age, still require treatment for breast and/or cervical cancer and have not exhausted their 18 months (breast cancer) or 24 months (cervical cancer) State funded BCCTP. Recipients eligible only for transitional emergency, pregnancy-related and State only LTC services, and State-funded cancer treatment and related services.

COHS N/A

GMC / CCI CCI*

SB

REGIONAL TWO PLAN

//CMCCMC*

MMLTLSTSSS*

N/A

N/A

N/A

N/A

Restricted Benefits. No share of cost. FFP Under 50%

01

Adult & Family

RCA. Covers all eligible refugees during their first 8 months in the US, including unaccompanied children who are not subject to the 8 month limitation.

M

V

OTLIC Full Benefits. No Share of Cost. FFP 100%

Refugee Medical Assistance (RMA)/Entrant Medical Assistance. Covers eligible refugees and entrants who

Adult & are not eligible for Medi-Cal or Healthy Families and do not qualify for or want cash assistance.

02

Family

M

V

OTLIC Full Benefits. Share of Cost and No Share of Cost. FFP 100%

Adoption Assistance Program (AAP). Covers children receiving federal cash grants under Title IV-E to

Adult & facilitate the adoption of hard-to-place children who would require permanent foster care placement without

03

Family such assistance.

M

V

OTLIC

Full Benefits. No Share of Cost. FFP 50%

AAP/Aid for Adoption of Children (AAC). Covers children receiving cash grants under the State-only

Adult & AAP/AAC program.

04

Family

M

V

OTLIC Full Benefits. No Share of Cost. FFP 50%

M

N/A

N/A

M

N/A

N/A

V

N/A

N/A

V

N/A

N/A

AbMbrevMiaatniodnaKtoeryy:

M Mandatory,

V Voluntary,

D VoVluntVaorylufnotraDryuals/Mandatory for Non-Duals,

P

MaDndVaotolurynftoaryNfaopraD, uSaolsa/nMoa, nYdoalotoornylyfo,

r NNo/An-NDoutainls

MaPnagMeadnCdaarteo.ry for Napa, Solano, Yolo only

6

Note, Coordinated Care Initiative (CCI), Cal-Medi-connect (CMC), and Medi-Cal

Mana*gDeduLoanlgsTeormnSluypp(oMrt &eSdervii-cCes a(MlL/TMSSe) adreicDauarlseonely l(Migedibi-Clael )

Medicare eligible). For information on California's Dual Eligible Population, visit

the CalDuals website at:



N/A not in Managed Care

Medi-Cal Managed Care Plans Mandatory or Voluntary Enrollment

by Medi-Cal Aid Codes

Updated: January 8, 2019

AID CODE

06

07

08 1E

RATE GROUP

PROGRAM / DESCRIPTION

COHS

Adoption Assistance Program (AAP) Child. Covers children receiving federal AAP cash subsidies from out

Adult & of state. Provides eligibility for Continued Eligibility for Children (CEC) if for some reason the child is no

Family longer eligible under AAP prior to his/her 18th birthday.

M

OTLIC Full benefits. No Share of Cost. FFP 50%

Title IV-E Extended AAP/FFP Medi-Cal. Adoption Assistance Program (AAP) Federal: A cash grant

program to facilitate the ongoing adoptive placement of hard-to-place non-minors, whose initial AAP

Adult & payment occurred on or after age 16 and are over age 18 but under age 21, and participating in one of five

Family conditions who would require permanent foster care placement without such assistance.

M

OTLIC

Full Benefits. No Share of Cost. FFP 50%

Entrant Cash Assistance (ECA). Covers Cuban/Haitian entrants during their first 8 months in the US who

Adult & are receiving ECA benefits, including unaccompanied children who are not subject to the 8 months

Family provision.

M

OTLIC

Aged

Craig v. Bonta Aged FCralligBv. Bofinta NAgeSdhPendinf gCSB 8F7FRPe1d0e0te%rmination. Covers former Supplemental Security Income/State

Supplementary Payment (SSI/SSP) recipients who are aged, until the county redetermines their Medi-Cal eligibility.

M

Full Benefits. No Share of Cost. FFP 50%

Federal Poverty Level ? Aged (FPL-Aged). Covers the Aged in the Aged and Disabled FPL program.

Pending SB 87 1H

Aged

Full Benefits. No Share of Cost. FFP 50%

M

GMC / CCI CCI*

SB

REGIONAL TWO PLAN

/ /

CMCMC C*

MMLTLSTSSS*

V

V

N/A

N/A

V

V

N/A

N/A

V

M

N/A

N/A

V

D

V

M

V

D

V

M

Re-determination. AbMbrevMiaatinodnaKtoeryy:

M Mandatory,

V Voluntary,

D

VoVluntVaorylufnortaDryuals/Mandatory for Non-Duals,

P MaDndVatoolruynftoarryNfaopraD, Suaolas/nMo,aYndoalotoornylyf,o

r N/oAn-NDoutainls

MaPnagMeadnCdaarteo.ry for Napa, Solano, Yolo only

7

Note, Coordinated Care Initiative (CCI), Cal-Medi-connect (CMC), and Medi-Cal

Man*aDgeud Laonlsg ToermnlSyup(poMrt &eSdeirv-iCcesa(Ml/LMTSeS)dariecDaurales oenlyli(gMeibdi-lCeal) Medicare eligible). For information on California's Dual Eligible Population, visit



the CalDuals website at: N/A not in Managed Care

Medi-Cal Managed Care Plans Mandatory or Voluntary Enrollment

by Medi-Cal Aid Codes

Updated: January 8, 2019

PROGRAM DESCRIPTION AID

RATE

CODE GROUP

PROGRAM / DESCRIPTION

COHS

Restricted FPL ? Aged. Covers the Aged in the Aged and Disabled FPL program that do not have

1U

Restricted FPL -- Aged. Covers N/A

satisfactory immigration statues. Benefits restricted to pregnancy and emergency services.

N/A

Restricted Benefits. No Share of Cost. FFP Under 50%

1X

Aged

tAheidAtgoedthinethAe gAgeedd -and Aid to the Aged ? Multipurpose Senior Services Program (MSSP). Allows special institutional deeming

rules (spousal impoverishment) for MSSP transitional and non-transitional services for individuals 65 years of age or older.

N/A

1Y 10 13

DAiidsatbolethdeFAPgLepdro1g-rMamSSthPa.t do Aged

Full Benefits. No Share of Cost. FFP 50% Aid to the Aged ? MSSP. Allows special institutional deeming rules (spousal impoverishment) for MSSP transitional and non-transitional services for individuals 65 years of age or older.

Multipurpose Senior Full Benefits. Share of Cost. FFP 50%

Aid to the Aged ? SSI/SSP.

nAAoildltothwoastvhesepsAeagcteiisadfla--icntsSotrSityuIIStioSnPa. l Full Aged

Full Benefits. No Share of Cost. FFP 50%

iSBmeemnerivgfitrisac.teiNoson SsPhtaartorueegosrf.aCBmoesnt.eFfiFtsP Aid to the Aged - LTC. Covers persons Aid to the Aged ? LTC. Covers persons 65 years and older who are medically needy and in LTC status.

Long Term

deeming rules (spousal Care Full Benefits. Share of Cost and No Share of Cost. FFP 50%

N/A M M

Aid to the Aged - Medically 65 years and old Aid to the Aged ? Medically Needy. r who are medically

r5e0s%tricted to pregnancy and 14

Aged

(MSSP). Allows special Full Benefits. No Share of Cost. FFP 50%

impoverishment) for MSSP needy and in LTC status. Full Aid to the Aged ? Pickle Eligibles.

16

Aged

NAiededtoy.thFeuAll gBeedne-fiPtsi.ckNloe em rgency services. Restricted Full Benefits. No Share of Cost. FFP 50%

institutional deeming transitional and non-transitional Benefits. Share of Cost and No Share AbMbreMvaiantdioantorKyey:

M Mandatory,

V

VoVlunVtoalruyn,t

arDy Voluntary for Duals/Mandatory

SEhligaribeleosf .CosFt.uFllFBPe5n0e%fits. Bseernveicfietss. fNoor iSnhdaivrieduoaf lCso6s5t. FFP of Cost. FFP 50% foDr NVoonlu-Dntuaarylsf,o

r DPuMalas/nMdaantodarytofroyrfoNraNpoan,-Duals P Mandatory for Napa, Solano, Yolo only

8

M M

Solano, Yolo only.

GMC / CCI CCI*

SB REGIONAL / TWO PLAN / CMC* MLTSS*

N/A N/A

N/A

N/A

N/A

N/A

N/A

V

M

N/A

N/A

V

D

N/A

N/A

V

D

V

D

V

M

V

M

V

M

V

M

V

M

Note, Coordinated Care Initiative (CCI), Cal-Medi-connect (CMC), and

Me*dDi-Caul aMalsnagoednLloyng(TMermeSdupi-pCorta& lS/eMrviceesd(iMcLaTSrSe) aerelDiguailbs olnely)

(Medi-Cal Medicare eligible). For infowrmwawti.ocnalodnuaClsa.loifrogrnia's Dual Eligible Population, visit N/A not the CalDuals website at: in Managed Care

 ................
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