2024 DHCS Medi-Cal Contract Transition – Counties California Health & Wellness Plan is transitioning to another health plan

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Counties

• Alpine
• Butte
• Colusa
• El Dorado
• Glenn
• Mariposa
• Nevada
• Placer
• Plumas
• Sierra
• Sutter
• Tehama
• Yuba

2024 DHCS Medi-Cal Contract Award Q&As

1. What happened to the RFP?
   DHCS has formally canceled the RFP and is using its authority to issue direct contracts on a county-by-county basis.
2. How long is the new contract?
   The contract will be five years, through December 31, 2028, auto-renewing at the end of each year for the next year.
3. What happens if the replacement plan in my county doesn't meet operational readiness requirements by January 1, 2024?
   Operational readiness is required effective January 1, 2024. DHCS reserves the right to extend contracts with existing plans should new plans require additional time to meet required readiness requirements.
4. What counties is California Health & Wellness Plan (CHWP) transitioning to another health plan on January 1, 2024?
   Alpine, Butte, Colusa, El Dorado, Glenn, Mariposa, Nevada, Placer, Plumas, Sierra, Sutter, Tehama, and Yuba counties will transition to other health plans effective January 1, 2024.
5. Do I need to cancel or amend my contract with California Health & Wellness Plan (CHWP) if CHWP no longer serves Medi-Cal members in my county?
   If California Health & Wellness Plan (CHWP) will no longer serve Medi-Cal members in your county, you don't need to do anything and your agreement can continue. If changes are needed to your agreement, your assigned Regional Network Director from CHWP will contact you.
6. Describe the member transfer process when Health Net is the transferring plan. Can Health Net block transfer a provider's Medi-Cal members to the health plan they chose (CHG or BlueShield Promise)?
   No. DHCS will transition the members.
7. What percentage of the membership will be awarded to each health plan (CHG & BlueShield)?
   If historical practice is any indication, we will not know until the transition is complete. DHCS will assign a member to a provider and health plan if the member does not select one. This assignment process is not expected to happen until later in 2023.
8. Will the DHCS provide additional funding to subsidize cost increases for the health plans, and will this funding be passed down to the IPAs to maintain cost neutrality?
   DHCS is required to set actuarily sound rates. Program and benefit changes are considered in the process. Rates are evaluated annually. Provider must engage in negotiations with their respective health plans as part of their normal negotiation cycles.
   
9.   Added December 7, 2023 – What happens to claims that span from 2023 into 2024, specifically for inpatient hospital visits?
   The responsibility is determined by the date-of-service and authorization timeframe.
   
   If a claim has a date of service on or before December 31, 2023, California Health & Wellness will be responsible for payment of appropriate claims if prior authorization approval is in place. Please send these claims to:
   
   California Health & Wellness
   Attn: Claims
   P.O. Box 4080
   Farmington, MO 63640-3835
   Payer ID: 68069
   
   Claims with a date of service on or after January 1, 2024, will be denied by California Health & Wellness. The new health plan will be responsible for payment of appropriate claims with a date of service on or after January 1, 2024. Please submit these claims to the new Medi-Cal plan.
10. Who do I submit questions to or contact if I need additional information?
    If you have additional questions or need additional information you can reach out to your Regional Network Director in Provider Network Management.