Healthy Families Program transition continues

California began the transition of its Healthy Families Program (HFP) to the Medi-Cal program on Jan. 1. The first phase of the transition, which moved nearly 200,000 children, was implemented after it received approval from the federal Centers for Medicare and Medicaid Services (CMS) late last year. The second wave of children transitioned (Phase 1b) on March 1, moving nearly 100,000 more children’s dental coverage into the Denti-Cal program.

The next wave of the transition is set to occur on April 1.  It is important to note that CMS is requiring the state to again seek approval before they initiate this next phase (Phase 1c).

Phase 1c of the transition includes approximately 105,000 children. This additional phase was created specifically for children who were being served by HealthNet in counties that were set to transition in March in Phase 1b. HealthNet needed additional time to try to ensure a sufficient network of health care providers to meet the needs of the children transitioning. HealthNet consumers, as well as Health Plan San Joaquin consumers, in the following counties are set to transition on April 1:

  • Kern;
  • Los Angeles;
  • Tulare;
  • Sacramento;
  • San Diego;
  • San Joaquin; and
  • Stanislaus.

Once these beneficiaries transition into the Medi-Cal program, dentists will need to bill Denti-Cal for any dental services provided. Dentists who are not Denti-Cal providers, but would like to become one so that they may continue to serve their current patients when they transition into that service delivery system, can visit the Denti-Cal website (www.denti-cal.ca.gov) for the Enrollment Application Guide.

Dentists currently serving children through the Healthy Families Program who do not wish to continue to serve them after their transition to Medi-Cal, should notify the dental plans they are currently contracted with as soon as possible and should notify the Department of Health Care Services (DHCS) by completing this short form. Dentists will also want to notify their patients, advise them of the importance of continued care, and support them in finding alternative care by referring them to the local dental society or advise them to contact DHCS at 800.322.6384.

Dentists who currently serve HFP patients who have not transitioned yet, or who are unsure if they have transitioned, can check eligibility through their normal HFP processes. If the patient is no longer eligible with HFP, dentists can check their Medi-Cal eligibility by calling 800.456.2387.

Denti-Cal has posted several new Denti-Cal Bulletins providing detailed information on the Healthy Families Program transition, which can be accessed at www.denti-cal.ca.gov.

CDA has been representing its members in all of the administration’s implementation meetings with stakeholder organizations, and has held many separate meetings with the department, legislative leaders and staff and advocates over the last few months regarding the Healthy Families Program transition. Those efforts continue.

CDA will keep members informed as this issue progresses. For more information, please contact Nicette Short at CDA at nicette.short@cda.org or 916.554.4970.