1115 Waiver Proposals California Children’s Services Program

Medi-Cal Managed Care Plan Fully-capitated, at risk Knox-Keene licensed plan providing services to entire population All children with all CCS eligible medical conditions Disenrollment from Healthy Families plan Mandatory enrollment

Medi-Cal Managed Care Plan Managing and/or coordinating all of the child’s health care needs Benefits  Medically necessary services to treatment the ‘whole child’  Same range of currently covered services Primary and preventive care Medically necessary services to treat the CCS condition  Care coordination Outreach and Assessment

Medi-Cal Managed Care Plan Provider network  CCS approved providers Hospitals Individual providers Special care centers

Medi-Cal Managed Care Plan Medical home and care coordination  Personal physician  Active family participation in decision- making  Information technology  Care coordinators to support physicans

Medi-Cal Managed Care Plan Medical home and care coordination  Participation in quality improvement activities Providers Patients and families

Medi-Cal Managed Care Plan Administration  24/7 nurse advise line  Member services  Member education Quality monitoring and improvement

Specialty Health Care Plan Fully capitated, at risk Knox-Keene licensed plan only providing services to children with CCS eligible medical conditions Managing and/or coordinating all of the child’s health care needs Mandatory enrollment Disenrollment from  Medi-Cal managed care plan  Healthy Families plan

Specialty Health Plan Provider network  CCS approved providers Hospitals Individual providers Special care centers

Specialty Health Care Plan Benefits  Medically necessary services to treat the ‘whole child’  Same range of currently covered services Primary and preventive care Medically necessary services to treat the CCS condition  Care coordination

Specialty Health Care Plan Medical home and care coordination  Personal physician  Active family participation in decision- making  Information technology  Care coordinators to support physicans

Specialty Health Care Plan Medical home and care coordination  Participation in quality improvement activities Providers Patients and families 24/7 access to care Reimbursement Quality monitoring and improvement

Specialty Health Care Plan Administration  24/7 nurse advise line  Member services  Member education  Member outreach and assessment