Overview of Medi-Cal for Child Welfare Agencies
Medi-Cal
All children who are in foster care are eligible to receive Medi-Cal that is either Fee-For-Service (FFS) or a Managed Care Plan (MCP). Access to Medi-Cal health plans depends on the California county in which the foster youth resides. Medi-Cal provides a core set of health benefits that can be viewed here: Medi-Cal Health & Dental Benefits.
The Department of Health Care Services (DHCS) added dyadic services and Doula services as as benefits effective January 1, 2023 for both MCP and FFS plans. Dyadic Services are a family and caregiver focused model of care intended to address developmental and behavioral health conditions of children and includes services provided to parent(s)/caregiver(s) (known as a “dyad”). Doula Services are supports provided for individuals and families throughout pregnancy and one year postpartum. This includes emotional and physical support provided during pregnancy, labor, birth, and the postpartum period, as well as support for and after miscarriage and abortion.
Fee-for-Service Plans (Straight Medi-Cal)
The FFS model, often referred to as Straight Medi-Cal, is a payment model where healthcare providers are reimbursed by the state of California for each individual service, they provide to Medi-Cal members (doctor visits, x-rays, etc.). With FFS plans, members can visit any provider who accepts Medi-Cal, obtain the needed service, then a claim would be submitted for payment that is determined, processed and paid (or denied) by the Medi-Cal program’s fiscal intermediary.
Profile of Enrolled Medi-Cal Fee-for-Service (FFS) Providers – Dataset – California Health and Human Services Open Data Portal.
Managed Care Plans
The MCPs receive a fixed per-member, per-month fee regardless of the services provided. The state contracts with MCPs to deliver a wide array of health care services to members, including primary care, specialty care, hospital services, prescription drugs. and preventative services. Once a Medi-Cal MCP is selected, members will select their primary care physician (PCP) within the MCP network. The PCP is the main contact point for coordinating member's healthcare needs.
The MCP Health Plan Directory breaks down the available MCP services by county. MCPs are available in 37 counties so a member must decide which MCP best serves their needs (if there is more than one option). There are 21 counties that provide the option between MCP and FFF so members must decide which best fits their needs. Child Welfare Agencies can support foster youth and their parents/caregivers by providing education and helping them compare the quality of providers and ensuring the key providers they need are within their health care plan.