In 1997, an estimated one million children were uninsured in California. The California State Legislature and the Governor enacted a new program known as the Healthy Families Program. Health Net, an IPA model HMO, under contract with the State of California Managed Risk Medical Insurance Board (MRMIB) is a major participant in this new program of care, consisting of twenty-five health plans, four dental plans and one vision plan.
The challenges associated with implementing a new delivery system in managed care within rural and urban communities required Health Net’s ability to demonstrate adequate services. Health Net was evaluated by MRMIB on the following key areas: special population access, geographic access and infrastructure.
Another unique feature of this program is that the treatment of children with special health care needs is “carved-out” of this contract. This new challenge led to the development and implementation of a Memorandum of Understanding (MOU) between public health and managed care for the purpose of care coordination.
This session will highlight the challenges and demonstrate the methods used to achieve the implementation of a new government program in thirty-eight counties in the state of California. The success that Health net has experienced in these counties is due in part to the role played by local public health agencies in sharing program experience.
Learning Objectives: 1) Understand the challenges associated in implementing a new State Children’s Health Insurance Program known as Healthy Families in Managed Care. 2) Articulate the role of Managed Care in providing low-cost comprehensive health care coverage to California children. 3) Describe the challenges and methods used to implement the Healthy Families Program and care coordination activities between public and private organizations in thirty-eight counties
Keywords: Child Health, Managed Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.