2024 DHCS Medi-Cal Transition – Health Net and Molina Healthcare membership-sharing

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County

• Los Angeles County

2024 DHCS Medi-Cal Contract Award Q&As

1. Added January 18, 2024 – What do I do if my patient was transitioned to Molina effective January 1, 2024, but wants to continue with Health Net as their preferred Medi-Cal plan?
   If your patient was transitioned to Molina but wants to stay with Health Net, please complete the Request for PCP/PPG Change Form – English (PDF) or Request for PCP/PPG Change Form – En Español (Spanish) (PDF) while the member is in the office, check the Health Net box on top of the form, and submit it to Health Net Medi-Cal Member Services via the fax or email provided on the form. The form must include a future effective date and be acknowledged and signed by the member. Allow for a 15 business-day turn-around time for processing. To obtain additional information about member transfers, please instruct your patient to contact Health Net Medi-Cal Member Services at 800-675-6110. They should follow the prompts to speak with an agent regarding their choice to transition back to Health Net.
2. Added January 18, 2024 – How will I know if my patient was transitioned to Molina effective January 1, 2024?
   If your patient was transitioned to Molina effective January 1, 2024, the Health Net provider portal will reflect the transition of the member to Molina. Additionally, AEVS will list Health Net as the healthcare plan and show the Molina transition arrangement.
3. Added January 18, 2024 – Did Health Net share open prior authorizations with Molina or am I required to request a new one and have it backdated to January 1, 2024?
   Health Net shared open prior authorizations with Molina. Molina has committed and agreed to honor these open prior authorizations.
4. Who is the prime contractor in Los Angeles County?
   In Los Angeles County, Health Net is the prime contractor directly contracted with DHCS. Health Net will subcontract to Molina Healthcare. L.A. County remains a two-plan model, and Molina will remain a subcontractor to Health Net and will remain accountable to Health Net to perform its obligations under the terms of our arrangement.
5. Do I need to contract with Molina if I have a contract with Health Net?
   Health Net cannot advise on other business relationships. Should a provider contract with only one plan, member/provider relationships will be maintained. Therefore, providers have the option to contract with only one plan, or with both plans. Members will remain with their existing providers.
6. If I have a contract with both Health Net and Molina, which one governs? If one contract gives higher rates, can I steer my patient to that plan?
   Provider contractual preferences will not be considered in the assignment process.
   
   DHCS will work with Health Net to transition members to Molina effective January 1, 2024, to help Molina reach 50% of Health Net's market share. Details on the specific process to execute on this transition will be further defined late in 2023. Some overarching principles have been finalized and include the following:
   1. Member choice must be honored. Members who choose a plan and/or provider will be assigned accordingly.
   2. Member and provider relationships must be preserved. Providers who have members today will keep their members through their contracted health plan(s).
   3. If a provider has a contract with only one plan, members will be assigned to the provider through only one plan.
   4. If providers are contracted with both plans, members will be assigned to the provider through both plans. There is no ability to support provider specific requests to direct members to one plan or another. Therefore, providers choosing to contract with both plans should expect to have membership through both Health Net and Molina.
   5. Family linkages will be made such that a member with no prior PCP relationship will be assigned to the PCP where the member's family is assigned.
   6. Members will continue to have the option to change plans and providers every month.
7. Will member assignments change in Los Angeles County?
   DHCS will work with Health Net to transition members to Molina effective January 1, 2024, to help Molina reach 50% of Health Net's market share. Details on the specific process to execute on this transition will be further defined late in 2023. Some overarching principles have been finalized and include the following:
   1. Member choice must be honored. Members who choose a plan and/or provider will be assigned accordingly.
   2. Member and provider relationships must be preserved. Providers who have members today will keep their members through their contracted health plan(s).
   3. If a provider has a contract with only one plan, members will be assigned to the provider through only one plan.
   4. If providers are contracted with both plans, members will be assigned to the provider through both plans. There is no ability to support provider specific requests to direct members to one plan or another. Therefore, providers choosing to contract with both plans should expect to have membership through both Health Net and Molina.
   5. Family linkages will be made such that a member with no prior PCP relationship will be assigned to the PCP where the member's family is assigned.
   6. Members will continue to have the option to change plans and providers every month.
8. How will transitioning 50% of Health Net's membership to Molina affect me?
   DHCS will work with Health Net to transition members to Molina effective January 1, 2024, to help Molina reach 50% of Health Net's market share. Details on the specific process to execute on this transition will be further defined late in 2023. Some overarching principles have been finalized and include the following:
   1. Member choice must be honored. Members who choose a plan and/or provider will be assigned accordingly.
   2. Member and provider relationships must be preserved. Providers who have members today will keep their members through their contracted health plan(s).
   3. If a provider has a contract with only one plan, members will be assigned to the provider through only one plan.
   4. If providers are contracted with both plans, members will be assigned to the provider through both plans. There is no ability to support provider specific requests to direct members to one plan or another. Therefore, providers choosing to contract with both plans should expect to have membership through both Health Net and Molina.
   5. Family linkages will be made such that a member with no prior PCP relationship will be assigned to the PCP where the member's family is assigned.
   6. Members will continue to have the option to change plans and providers every month.
9. When are the member letters getting distributed?
   Member letters (PDF) are distributing by December 1, 2023.
10. What if the member does not want to get re-assigned to Molina as described in the letter?
    Members can choose to remain with Health Net and not be reassigned. They can contact the Health Net Member Services at 800-675-6110 for help.
11. Will the DHCS provide additional funding to subsidize cost increases for the health plans, and will this funding be passed down to the IPAs to maintain cost neutrality?
    DHCS is required to set actuarily sound rates. Program and benefit changes are considered in the process. Rates are evaluated annually. Provider must engage in negotiations with their respective health plans as part of their normal negotiation cycles.
12. If a Health Net member is transitioned to Molina but chooses to get reassigned back to Health Net, will the effective date of the reassignment be retroactive back to January 1, 2024? Or, will the effective date be the 1st of the month following the date the member submits the reassignment request?
    All member reassignments must follow our standard member reassignment process, which includes adhering to the specified timing parameters as follows:
    • 1st of the current month - if services have not been rendered by their current provider.
    • 1st of the following month - if services have been rendered by their current provider.
13. What is the deadline for a member to submit a request to be reassigned back to Health Net for an effective date retroactive to January 1, 2024?
    All member reassignments must follow our standard member reassignment process, which includes adhering to the specified timing parameters as follows:
    • 1st of the current month - if services have not been rendered by their current provider.
    • 1st of the following month - if services have been rendered by their current provider.
14. How do I request a copy of our member roster sent to Health Net by the DHCS prior to Health Net integrating the IPA affiliations and sending the file to Molina?
    Molina will be providing PPGs a list of members transferring from Health Net to Molina in December as well as in January. The goal is to provide the information as early as possible to help PPGs prepare.
15. Does the DHCS have an edict that mandates members transitioned from Health Net to Molina must remain with their current PCP and their current IPA? Or, does the policy state that members transitioned to Molina must only remain with their current PCP?
    DHCS will ensure that members remain connected to their current PCP. Health Net is adding PPGs and IPAs to the file received from DHCS. Molina has made a commitment to keeping members with both their PCP and PPG.
16. Is Health Net financially responsible for authorized inpatient care of a patient who has been transitioned to Molina if they were admitted prior to January 1, 2024 and remain inpatient post January 1, 2024?
    If a member's admission was authorized under a specific health plan, then that health plan would continue to cover the authorized in-patient services, even if the member's eligibility were to expire during the member's stay.
17. Who do I submit questions to or contact if I need additional information?
    If you have additional questions or need additional information you can reach out to your Regional Network Director in Provider Network Management.