Lake County residents who receive health coverage through the state's Medicaid program are being transferred to a managed health care organization beginning Sunday.
The county is one of eight rural counties in Northern California whose Medi-Cal clients will become part of Partnership HealthPlan, or PHC. Other counties include Del Norte, Humboldt, Lassen, Modoc, Shasta, Siskiyou and Trinity.
The move was approved by the state in March, and both county and PHC have been informing Medi-Cal clients in these counties that they must chose a new primary care physician.
“Our recipients were notified months ago of the need to designate a primary care physician and, providing that they did so, it should be a seamless transition,” said Carol Huchingson director of Lake County social services.
Huchingson said that she expects all current medical providers who accept Medi-Cal, the California's federal Medicaid program, to continue to do so under the new managed care system.
The switch is part of a state-wide effort to move all Medi-Cal patients to a managed care model. PHC uses a capitation payment system, where providers are paid per patient rather than the traditional Medi-Cal fee-for-service model.
There are about 17,000 Medi-Cal recipients in Lake County. Sonoma County's Medi—Cal population, about 60,000 residents, switched over to PHC in 2009, said PHC spokesman Dave McCallum.
McCallum said those who have not yet chosen a primary care physician by Sept. 1 will have one assigned to them based on their zip code. Thereafter, people can change their doctor at any time, though the change will not go into effect until the first of the next month.
McCallum said that soon under PHC's managed care model, Medi-Cal clients receive a “medical home” that better coordinates their care and offers supplemental benefits that are not covered by the state's traditional Medi—Cal program.
For example, Medi-Cal members enrolled in PHC will be offered substance abuse benefits as well as other former Medi-Cal benefits that were cut by the state, such as audiology, podiatry services for diabetic patients.
PHC, which started in 1994, provides managed care for roughly 300,000 Medi-Cal members in 14 counties. The addition of the eight rural counties added 105,000 of those members.
One of the plan's main goals is to increase the number of physicians who will accept Medi-Cal members.
“We've been able to expand the total number of providers that except medical in all the counties where we have been operating,” McCallum said.
You can reach Staff Writer Martin Espinoza at 521-5213 or firstname.lastname@example.org