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Project Details

Evaluating the Transition of Seniors and Persons with Disabilities to Mandatory Medi-Cal Managed Care: Telephone Survey and Focus Groups

image of man looking at pill bottle under evaluation project of Medi-Cal Managed Care in California
Project Summary: 

California is one of the first states to begin the process of Medicaid expansion as part of the Affordable Care Act. The first step in Medicaid expansion was to transition 380,000 seniors and persons with disabilities on Medi-Cal from fee-for-service to a managed care delivery system. Dr. Carrie Graham of HRA is evaluating beneficiary experiences with this mandatory transition, which was implemented between June 2011 and May 2012 as part of California’s Bridge to Reform Waiver. The evaluation is funded by the California Health Care Foundation and the California Department of Health Care Services (DHCS).

There is some evidence that managed care may improve coordination of and access to care for beneficiaries. However, the transition to managed care risks disrupting existing care arrangements, a possibility that could be dangerous for this high-needs population. In implementing the transition, DHCS offered beneficiaries a choice between two or more Medi-Cal managed care plans in each county. For those who did not make a choice, DHCS searched fee-for-service utilization data to identify physicians that the beneficiary had seen in the past. If a beneficiary’s past provider was in the network of a particular plan, then DHCS assigned the beneficiary to that plan. DHCS also allowed beneficiaries with certain complex medical conditions to file a Medical Exemption Request to remain in fee-for-service Medi-Cal.

Major Objectives
This evaluation will determine the prevalence of positive, neutral and negative experiences among seniors and persons with disabilities who were mandatorily transitioned from fee-for-service Medi-Cal to Medi-Cal managed care. It will suggest means to identify categories of beneficiaries who are likely to have more difficulties with such transitions. It will assess whether efforts made to link beneficiaries with a plan network that includes providers seen in the past had any statistically significant effect on continuity of care or beneficiary satisfaction. Finally, the evaluation will examine whether the profile and experiences of beneficiaries who filed and were denied Medical Exemption Requests differed significantly from those of other Medi-Cal managed care enrollees.

The evaluation utilizes both telephone survey and focus group methodologies. The telephone survey—conducted in English and Spanish—will document the experiences of 1,515 randomly selected Medi-Cal beneficiaries who transitioned to Medi-Cal managed care between June 2011 and May 2012. Survey staff received special training for conducting interviews with persons with disabilities. Persons using sign language can take the survey through video relay or instant messaging technology. Other accommodations, such as the use of proxies, or completion of the survey in installments, are available as needed.

Focus groups supplement the telephone survey, allowing researchers to document the experiences of additional language groups, hard-to-reach populations, and small but medically vulnerable groups. The evaluation includes focus groups with the population’s three largest language groups after English and Spanish. These are Armenian, Vietnamese, and Chinese. Additional focus groups document the experiences of beneficiaries who are homeless or marginally housed, those on dialysis and those with developmental disabilities.

Main Findings: 
Preliminary findings are being shared with DHCS and our stakeholder advisory group and are being used to inform the next phases of the Medicaid expansion, including the transition of dually eligible beneficiaries and the implementation of the Low Income Health Plan. Findings will be publicly available by February of 2013.
Policy, Practice or Research Impacts: 

This evaluation of California’s experience transitioning seniors and persons with disabilities to Medi-Cal managed care will help inform similar transitions in California and other states. Most immediately, the California Department of Health Care Services (DHCS) plans to transition persons eligible for both Medi-Cal and Medicare to Medi-Cal managed care beginning in June 2013. The evaluation findings will allow the California Department of Health Care Services, Medi-Cal health plan administrators, and advocacy groups to identify and improve the most problematic aspects of the transition process, and to target outreach and education efforts to those populations most at risk of experiencing difficulties.

Contact Person: 
Kira Foster
Contact Person's Email Address:
Health Research for Action / UC Berkeley School of Public Health
Principal Investigators: 
Dr. Carrie Graham
California Health Care Foundation; California Department of Health Care Services
Location - States: