Medicaid Managed Care - U.S. Senate Special Committee on Aging

B-2760e7
473
contracted with the local initiatives on a sole-source basis, while the
commercial plan contracts were awarded on a competitive basis.
The situation in Los Angeles County, however, is unique. While California
contracted with a local initiative and a commercial plan in Los Angeles
County, the county has, in essence, IA plans beesirse the Iocal Ln~itistive
plan subcontracted with 7 plans, and the commercial plan subcontracted
with 2 plans.) Beneficiaries can choose a primary care physician from any
one of the Ill plans.
Health <strong>Care</strong> Options Medi-Cal beneficiaries required to enroll in the two-plan expansion
Programn Educates and program are infonned about managed care and their choices of health care
Enrolls Beneficiaries plans through oDR' Health <strong>Care</strong> Options (nuo) program, nun also enrolla
and disenrolls beneficiaries in managed care plans) 0 The state contracts
with an enrollment broker to conduct Iwo program activities.
Beneficiaries are informed about the mandatory expansion program and
their available choices primarily through an enrollment packet that they
receive through the mall. The enrollment packet includes information on
managed care, how to join a health plan, available plans and participating
providers, phone numbers to call for assistance, and an enrollment form.
The packet also includes the first of three standard notices that inform,
beneficiaries of the 30-day tone frame in which they have to choose a plan
and the plan to which they will be automatically assigned if they do not
retura an enrollment form.l
Beneficiaries also can teamn about the two-plan model and their plan
options at iio presentations, which are often held daily at county social
service offices. At these face-to-face presentations, nun0 counselors provide
information on managed care, plans available in the county, how to fill out
"trve elan p . At thee i fac e-LA o-eae p nittin, C.CO- , LA cunselors noideth
Plan, Miate Unid o a Pl, Towr, plansd aie Fnlaln Itei PIan. The plan pfnr in
Ule e--ai pL-FouPondanon lie-al Syn-a tIninena care a d Mohla Meriecs cenler
Unlike Fnndnlinn Wealdi Synen, LA Cae dnen no- dineely pirMd& tith -eas srnuices.
"R'un Mtl-cal <strong>Managed</strong> can and Pyweni Syan-- diNini-diae rep-dbwlauy for 1ir0uc ~
pngewn The MediCal <strong>Managed</strong> Cane DtnIAn wakes aWl pnley delhadn rearding le hCpOg while
tire Pyeen Syletn DMni..innl-nwn and manges lh~Ire ttpengra and wnwnr HCO
ninitie, hie a enntd n a eneandin hbrker The Psyweni Synlent Dtiesion Sumned Uis
en .osa bilay fron l Medical <strong>Managed</strong> Ca l)in-n w Maidh 1997.
;'Ths ale n igt efiann edreg loom, e- asbhed eretirolosy. which genealy ipale
other benrtday who did -rl choane a plan to the enommnerr plan Bleneflcren wh.- w lrdy
enolled Ia on nti plain openting under , lr Iwo plan eodel ame not -nwgned by tlr wal
&eneirciarlelw he tire opon la ehapne pLao at aiy IIe.
PaIF 7
aeAOiHEHS-98-2 CaIli-nnla's Maaged care C-Eapnsin