Under CalAIM, Medi-Cal managed care plans (MCPs) will cover and coordinate Medi-Cal institutional Long-Term Care (LTC) in all counties in 2023 in a phased approach by facility type. This will provide all LTC residents with access to coordinated and integrated care within Medi-Cal managed care, and make coverage consistent across California. The goal of the Medi-Cal LTC carve-in is to better integrate care across institutional and home- and community-based settings as well as to make the LTC delivery system consistent across all counties in California. MCPs can offer complete care management, and provide a broader array of services, including Enhanced Care Management and Community Supports.
LTC includes skilled nursing facilities, subacute facilities, pediatric subacute facilities, and intermediate care facilities.
January 1, 2023 Transition
Effective January 1, 2023, all MCPs are responsible for the full LTC benefit at the following facility types and homes:
- Skilled Nursing Facility (SNF), both freestanding and hospital-based SNFs
Medi-Cal beneficiaries residing in these facilities will begin receiving communications about these changes in November 2022.
The 31 counties where SNF coverage is newly transitioning from Medi-Cal fee-for-service (FFS) to the Medi-Cal managed care, and beneficiaries are enrolling in Medi-Cal managed care are:
Alameda, Alpine, Amador, Butte, Calaveras, Colusa, Contra Costa, El Dorado, Fresno, Glenn, Imperial, Inyo, Kern, Kings, Madera, Mariposa, Mono, Nevada, Placer, Plumas, Sacramento, San Benito, San Francisco, San Joaquin, Sierra, Stanislaus, Sutter, Tehama, Tulare, Tuolumne, and Yuba.
January 1, 2024 Transition
Effective January 1, 2024, all MCPs will become responsible for the full LTC benefit at the following facility types and homes:
- Intermediate Care Facility for Developmentally Disabled (ICF/DD);
- Intermediate Care Facility for the Developmentally Disabled – Habilitative (ICF/DD-H);
- Intermediate Care Facility for the Developmentally Disabled – Nursing (ICF/DD-N);
- Subacute Facility;
- Pediatric Subacute Facility.
Note: ICF/DD-Continuous Nursing Care (ICF/DD-CN) homes are not subject to the LTC Carve-In policy.
Additional information regarding the Subacute LTC Carve-In is forthcoming.
Important Updates
Frequently Asked Questions and Resources for Managed Care Plans
DHCS has developed two documents to serve as resources for stakeholders that may be found under Key Documents. The first document is a Frequently Asked Questions (FAQ) document addressing stakeholder inquiries regarding CalAIM implementation, benefits, transition and care coordination, payment and rates, quality improvement, and policies and procedures. The FAQ was developed to help provide clarity to some stakeholder questions received during the CalAIM SNF LTC Carve-In educational webinar series. The second document is the CalAIM SNF LTC Carve-In Resources for MCPs document informed by the LTC Carve-In Workgroup, which shares promising practices and model contract language to support plan readiness.
Member Notices
DHCS mailed two versions of the LTC SNF Enrollment Notices to members 60-days and 30-days prior to January 1, 2023 driven by member population type. The LTC SNF Enrollment Notices and Notice of Additional Information may be found under SNF Key Documents.
Members not part of the Medi-Cal matching plan policy received notices that included the name of the managed care plan to which the beneficiary would be enrolled, if they did not choose a managed care plan by the default date. DHCS used an upfront provider linkage process that assigned a member to an MCP that worked with their LTC facility. If their LTC facility did not work with an MCP in their county, a default process was used.
Members that were part of the
Medi-Cal matching plan policy received notices that included the name of the managed care plan to which the beneficiary would be enrolled in based on their Medicare Advantage Plan enrollment. The State has a Medi-Cal matching plan policy in certain counties. This means that if the member joined a Medicare Advantage plan and there was a Medi-Cal plan that matched with that plan, they must choose that Medi-Cal plan. This policy did not change or affect their choice of a Medicare plan.
SNF LTC Carve-In Workgroup
The SNF LTC Carve-In Workgroup was established in December 2021 to provide an opportunity for key stakeholders to collaborate and help inform DHCS’ policy and operational efforts for the LTC Carve-In. Workgroup participants included Medi-Cal MCP representatives, advocates, providers, and associations. The Workgroup leveraged the expertise of members from the SNF LTC carve-in transition in CCI counties, considered perspectives from Medi-Cal members, LTC facilities and homes, and MCPs, and prioritized the maximization of independence for members.
The Workgroup convened seven times, from December 2021 through September 2022. Topics discussed at these meetings included the state of LTC services and coverage for Medi-Cal beneficiaries in 2022, MCP readiness, continuity of care, data sharing, facility communication and education needs, MCP oversight of LTC facilities, member communications, billing and payment, updates from the
2022 – 23 Governor’s Budget, and network readiness requirements. These meetings were key to informing policies, requirements, and promising practices for the SNF LTC Carve-In and resulted in the finalization of APL 22-018 SNFs – LTC Benefit Standardization and Transition of Members to Managed Care, FAQs, and the CalAIM SNF LTC Carve-In Resources for MCPs.
SNF LTC Carve-In Educational Webinars
DHCS is hosting a series of public educational webinars for the SNF LTC Carve-In transition to support Medi-Cal MCPs and the LTC provider network (specifically SNFs) as they prepare for this transition. The goal of these educational webinars is to inform stakeholders of the SNF LTC Carve-In policy requirements and how to best prepare to support and coordinate care for members. The webinars occur monthly beginning in October 2022 through February 2023. SNF providers and Medi-Cal MCP representatives are encouraged to attend, and webinars are open to the public. Details are provided in the Informational Webinars section below.
Key Documents
English Notices to Members:
Spanish Notices to Members:
Informational Webinars
To support stakeholder planning and implementation, DHCS hosted a SNF Carve-In education webinar series that concluded in February 2024. All materials from each webinar can be found below.
Past Webinars
Policy Update: Friday, February 24, 2023 at 2:00 pm.
How Medi-Cal Managed Care Supports SNF Residents Webinar: Monday, January 30, 2023 at 2:00 p.m.
SNF LTC Billing and Payment Rules: Friday, December 2, 2022 at 1:00 p.m.
Promising Practices for SNF and MCP Contracting: Friday, November 4, 2022 at 1:00 p.m.
SNF LTC Carve-In 101 for SNFs: October 7, 2022 at 1:00 p.m.
SNF LTC Carve-In 101 for MCPs: September 21, 2022 at 10:00 a.m.
