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Date: Monday, Jan. 22, 1996 FOR IMMEDIATE RELEASE Contact: HCFA Press Office (202)690-6145
HHS Secretary Donna E. Shalala today announced approval of California's Two-Plan Model to expand Medicaid managed care in 12 counties. The Two-Plan Model will be implemented on a county-by-county basis, and it is expected to be fully implemented over the next two years. Once implemented, this will be the largest Medicaid managed care initiative in the nation.
Secretary Shalala stated, "California's Two-Plan Model serves as an example of the administration's continued commitment to work with states in the development and implementation of innovative health care delivery systems designed to meet their specific needs."
The Two-Plan Model is unique to the characteristics of California's health care financing and delivery system in its utilization of both existing private and county health care providers. Twelve counties in California have been designated to implement the Two-Plan Model. These counties are: Alameda, Contra Costa, Fresno, Kern, Los Angeles, Riverside, San Bernardino, San Francisco, San Joaquin, Santa Clara, Stanislaus, and Tulare.
Medicaid beneficiaries in these 12 counties will be offered a choice of two managed care plans. One will be a "Mainstream Plan" offered by a commercial HMO and selected by the state. The other plan will be a "Local Initiative Plan" which will include existing county hospitals and health care facilities, as well as other local providers.
Bruce C. Vladeck, administrator of the Health Care Financing Administration, said that "The Two-Plan Model is an ambitious Medicaid managed care initiative, which resulted from six months of intensive review and dialogue between HCFA and the state of California. By providing Medicaid beneficiaries the choice between private and public providers, it will allow California's existing health care delivery system to be used in a new and unique fashion." Vladeck added, "This is a very important initiative, and we will be watching it closely."
Both the state and HCFA must ensure that the plans meet all access, quality and financial requirements before the Two-Plan Model can become operational in any county.
All Aid to Families with Dependent Children (AFDC) and AFDC-related Medicaid beneficiaries will be required to enroll in the program. Enrollment will be voluntary for other Medicaid beneficiaries. It is expected that once the Two-Plan Model is fully implemented, 3.3 million Medi-Cal beneficiaries will be enrolled.
Medicaid beneficiaries will be informed about the Two-Plan Model and the changes in their health care delivery through an independent enrollment contractor. The contractor will inform beneficiaries of their rights and responsibilities under the Two-Plan Model, including the need to choose a health plan and the range of services and providers available through each health plan.