Repeat Session!
August 6, 2020
1:30 – 3:00 p.m., Pacific Time

Registration is now closed.

Overview

Who does the Medi-Cal program cover?
How does one become eligible for Medi-Cal?
How does an individual get enrolled in a Medi-Cal Managed Care plan?

The Medi-Cal program is critically important to more than 13 million Californians — 10.6 million of whom receive their health services through managed care. But despite its broad reach, not everyone is eligible for Medi-Cal. Because the program is jointly funded and administered by the federal and state governments, specific eligibility requirements must be met and verified before individuals can access and receive care. Such eligibility information, which is procured through the application and verification processes, provides health plans with vital information about the characteristics and needs of the members they serve.

Join us for this introductory webinar and learn more about Medi-Cal eligibility and enrollment, including who’s eligible, the different pathways to eligibility and enrollment, how the enrollment process works, and how individuals are assigned to and enrolled in a managed care plan.

Who should attend:
Local health plan staff from all departments and at all levels who have an interest in understanding the basics of eligibility and enrollment or perform functions that are connected to or impacted by Medi-Cal eligibility and enrollment activities.

Agenda

Medi-Cal Eligibility — Context & Overview

• Joint federal and state-governed program with prescribed guidelines and requirements
• How federal requirements affect Medi-Cal eligibility

Who’s Eligible for Medi-Cal Coverage?

• Covered populations
• Modified Adjusted Gross Income (MAGI) and its impact on eligibility
• MAGI vs. non-MAGI populations — why this distinction is important

Pathways to Eligibility & Enrollment

• “No wrong door” approach to enrollment
• Pathways by which individuals can enroll
• What happens once an application is filed
• Redetermination process for maintaining coverage

Enrolling in a Managed Care Plan

• How individuals enroll in a managed care plan
• How different plan models impact enrollment processes
• Issues around enrollment — changing health plans,
  auto-assignments

How Plans Use Eligibility Information

• Aid codes — what they are and why they’re important
• How aid codes are used by plans and the State

Member Education & Outreach

• Plan approaches for education and outreach to members on eligibility and enrollment

Faculty

Cathy Senderling-McDonald
Deputy Executive Director
California Welfare Directors Association

Cathy Senderling-McDonald is the Deputy Executive Director of the County Welfare Directors Association (CWDA) where she works to promote legislative, budget and policy changes that improve human services programs and the delivery of those services. Prior to joining CWDA, she served as the California Senate Budget Committee consultant for social services programs, as well as a fiscal and policy analyst for the California Legislative Analyst’s Office. She has a bachelor’s degree in journalism from the University of Missouri at Columbia and a master’s degree from the Heinz School of Public Policy and Management.

Thomas Pham
Vice President of Strategy
Inland Empire Health Plan

Thomas Pham, VP of Strategy for Inland Empire Health Plan (IEHP), leads the development and facilitation of IEHP’s strategic planning process and oversees the diversification and implementation of new products and new business. He is also responsible for strategies to improve and enhance IEHP’s existing products and membership growth.

In his most recent role as Senior Director of Marketing and Products, Thomas managed the Communications and Marketing, Product Management, Medi-Cal Enrollment and Medicare DualChoice Enrollment teams. 

Thomas received a Master’s in Public Health with an emphasis in Healthcare Administration from Loma Linda University and bachelor’s degrees from the University of California, Los Angeles.

Carolyn Thon
Project Manager, Customer Support
Health Plan of San Mateo

Carolyn Thon is currently a Project Manager for Customer Support at the Health Plan of San Mateo (HPSM). She has been with HPSM since July 2005. Carolyn was previously the Chief Support Officer at HPSM. She was responsible for customer support, including member call centers, eligibility and outreach, grievance and appeals and enrollment/disenrollment for HPSM’s Duals Special Needs Plan and Medicare-Medicaid Cal MediConnect program.

Before joining HPSM, Carolyn worked for 25 years with the County of San Mateo. Carolyn held numerous financial and administrative management positions at the San Mateo Medical Center, the County’s public hospital and clinic system. Among her responsibilities were the hospital and clinics revenue cycle (patient access and eligibility and patient financial services), case management and utilization management, medical records, quality improvement and Joint Commission preparation. She also served as the fiscal officer for ambulatory care services and oversaw the County’s Healthcare for the Homeless federal grant.

Carolyn has an MPA from Syracuse University and a BA in Political Science from Pitzer College.

Registration

This is an LHPC members-only program.

Fees    $30* (per connection)
*Special registration pricing will be offered while health plan staff work remotely. Standard pricing will resume once staff return to work
on-site. Registration closes Aug. 3 at 5:00 p.m.

Registration Confirmation: Registrants will receive an email confirmation that will contain a link to the program participant information web page. The web page provides helpful instructions for accessing the program and any accompanying materials.

Participating in the Webinar: You will only need a computer with a web browser (Google Chrome or Mozilla Firefox is recommended) and a telephone. Audio for the program will be available via toll-free number or by using your computer speakers. 

Cancellation and No-Show Policy: Cancellation notification must be submitted in writing to institute@lhpc.org seven or more days prior to the course date. Refunds will not be given after that date. Substitutions are encouraged. Payment will be due for registered individuals that do not attend or participate in the event, and for which a cancellation notice is not received.