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Medi-Cal preparing customers For major changes next year


Coverage for undocumented immigrants

With the new year around the corner, Medi-Cal has expanded its coverage and benefits to include undocumented immigrants in 2024. The new services aim at meeting not just individuals, but community health care needs, and transforming California's health care for the better. 

After the Medi-Cal unwind that happened earlier this year, resulting in many people losing their medical benefits, Medi-Cal made it a priority to stop that from happening again to existing and new clients. They began having open enrollment and created an online dashboard for customers to check their status and what documents are needed for the process to move along.

Beginning in 2024, Medi-Cal health plans will have new requirements to advance quality, access, accountability, health equity, and transparency. Some Medi-Cal members in 21 counties may need to transition to a new health plan on January 1, 2024. This change does not affect members’ Medi-Cal coverage or benefits. Members’ Medi-Cal coverage and benefits will stay the same even if their Medi-Cal health plan changes.

"At the start of January, some plans will change based on the county and the needs of residents there. Managed Care and Planned Model type are plans that will see changes in particular counties,” said Michelle Retke, chief of managed care operations with Medi-Cal. “The main takeaway I want customers in counties that will potentially experience change to understand is to not worry about the changes until they receive a notice in the mail. Once they do, they simply follow the directions listed, and the process is done." Retke added that she wants customers to understand that this is not another unwinding period but an expansion period and a way to better services. 

 As a result of the new requirements, members can expect the following improvements:

  • Coordinated access to care: Members who need extra help will have access to care management based on their health care needs. This means having a designated point person, a care manager, who can assist them and their families in navigating the healthcare system, handling referrals, and supporting communication with providers.
  • Better behavioral and physical health integration: Members’ physical health care will be integrated with their behavioral health care, narrowing the divide between the two and improving access to mental health support and substance use disorder treatment. 
  • Reinvestment in the community: For the first time, MCPs (Medical Claims Processing System) and their fully delegated subcontractors with positive net income will be required to allocate five to 7.5% of these profits (depending on the level of their profit) to local community activities that develop community infrastructure to support Medi-Cal members. Plan partners will be required to annually submit a community reinvestment plan and report that details how the community will benefit from the reinvestment activities and the outcomes of such investments.

To learn more about the programs and the changes happening and to see if your county is affected visit the Medi-Cal website.