1. Lessons Learned from Other Transitions Family Voices of California 14 th Annual Health Summit March 14, 2016 Sujatha Jagadeesh Branch Disability Rights California

2. OVERVIEW  -Lessons learned from previous major changes in healthcare delivery -Information about CCS issues clients have experienced

3. PAST CHANGES Numerous major changes in California’s publicly funded health care systems since the 1990s: -Availability of HCBS waived -Medi-Cal managed care, 1990s -Healthy Families (SCHIP)

4. Past Changes (Continued) -Medi-Cal managed care for seniors and persons with disabilities -Medi-Cal managed care for rural areas -CCI

5. HCBS Waivers -Reduce institutionalization, provide people with more appealing options at home with their care needs being met. -Reduce institutional bias in Medicaid programs.

6. Med-Cal Managed Care Families with children and people without disabilities transitioned into Medi-Cal managed care in the past. Population had fewer ongoing Medical needs

7. HEALTHY FAMILIES, SCHIP -More Insurance available for more children, with a higher payment rate for providers -Insurance program with premiums -But, issues with ABA availability when Healthy Families was folded into Medi- Cal

8. Medi-Cal Managed Care for Seniors and Persons with Disabilities -The transition process -Availability and understandability of information about the transition -Preserving expertise of existing providers -Clients’ relationships with providers -Payment rates, and how they affect incentives of providers

9. Medi-Cal Managed Care for Seniors and Persons with Disabilities, Rural Transition -All of the above, plus -Availability of providers—there aren’t more than there used to be -Some rural providers and advocates say its critical to have community connectedness to ensure availability of services

10. CCI Transition -Major changes -Potential for better coordination? -Lack of understanding by insurance companies regarding activities of daily living, like IHSS program

11. LESSONS FOR CCS [1 Of 2] -Major change: importance of moving slowly -Insurance companies being responsible for services they aren’t familiar with -Challenges of finger-pointing -Go slowly -Obtain robust stakeholder input

12. LESSONS FOR CCS [2 Of 2] Have a transparent change process Effective communication about the transition and how to navigate managed care Meeting the needs of diverse communities People with more complex needs may have a harder time with transition Robust case management as a positive-- a place where responsibility lies People who may have received NOAs, but only realized they were in managed care when pharmacy refused to cover a prescription or doctor said she wasn’t in the network.

13. Lessons From CCS -Decision-making and deference to doctors with significant expertise -Due process concerns, lack of notices, lack of information -What is covered, and why -Interrelationship with Medi-Cal, and EPSDT coverage.