Do I need a Medi-Cal managed care plan?

If your child is a Medi-Cal recipient with private health care coverage, you may have heard that you’ll soon be required to assign your child’s Medi-Cal to a managed care plan instead of “fee-for-service” Medi-Cal coverage.

This is a big change. For over a decade, Medi-Cal recipients with Other Health Coverage (OHC) have been exempt from mandatory enrollment in a managed care plan. On January 1, 2022, however, a program called CalAIM went into effect. Among other things, the program is designed to streamline the delivery of Medi-Cal services in the community. Going forward, only those with medical exemptions will be eligible to remain under fee-for-service Medi-Cal.

The program is staged to take place over the next three years. According to the Department of Health Care Services, people with Supplemental Security Income (SSI)-linked Medi-Cal saw the change go into effect on January 1, 2022. For those who are enrolled in a Medi-Cal Home and Community-Based Services (HCBS) waiver — including the Regional Center institutional deeming waiver — and for those who are dually eligible for Medi-Cal and Medicare, the change won’t take effect until January 1, 2023.

For more information about this, see our article Big Changes Coming to Fee-for-Service Medi-Cal.