Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Blue Cross of California Partnership Plan, Inc. are independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Anthem is committed to bringing the power of one of California’s most respected companies to work for everyone. That is why we worked with the state of California to design our Medi-Cal program.
This program design has become the foundation for our programs in other states. For more information about Medi-Cal, visit the Medi-Cal provider website.
Dual-eligible individuals are eligible for benefits under both Medi-Cal and Medicare. Anthem has signed a three-way contract with CMS and the state of California’s Department of Health Care Services (DHCS) to participate in Cal MediConnect. For such dual-eligible beneficiaries, the Anthem Blue Cross Cal MediConnect Plan coordinates the medical, behavioral health, long-term care, and Home- and Community-Based Services (HCBS) from a single plan.
Here’s what providers need to know about the Anthem Blue Cross Cal MediConnect Plan:
For more information about Cal MediConnect, please visit www.calduals.org.
Anthem has been a participating plan with Major Risk Medical Insurance Program (MRMIP) in California since its inception. MRMIP offers subsidized coverage to Californians who are considered high-risk because of their medical conditions. These individuals are either medically uninsurable or are not able to obtain adequate coverage. Californians qualifying for the program participate in the cost of their coverage by paying premiums. The state supplements those premiums to cover the cost of care in MRMIP. Tobacco tax funds currently subsidize the MRMIP.
In addition to participating as a managed care organization, Anthem also serves as the vendor responsible for administering this program for the state of California. Those duties include managing eligibility, enrolling members in their choice of health plan, and collecting premiums for the program.
For more information about MRMIP, please visit the MRMIP page on the DHCS website.
The Medi-Cal Access Program (MCAP) is designed for pregnant women without health insurance in the middle-income bracket, but with incomes too high to qualify for no-cost Medi-Cal. Pregnant women with health insurance that includes a separate maternity services deductible or copay of $500 or more may also be eligible for MCAP coverage. Anthem contracts with the state of California to provide services to eligible members through our PPO or HMO, based on where the member lives.
MCAP covers comprehensive health care from the effective date of coverage in MCAP until the last day of the month in which the 60th day following the end of the pregnancy occurs. Pregnant women can apply at any time during their pregnancy but must meet all other MCAP eligibility requirements. Their newborns are also eligible for enrollment in MCAP.
For detailed information about MCAP services, eligibility information and enrollment instructions, please visit the DHCS program page.
Anthem was selected by the California DHCS and the California Department of Public Health to provide LTSS health care services for Medi-Cal members in Los Angeles and Santa Clara counties. LTSS is part of the Coordinated Care Initiative (CCI) created in partnership between DHCS and the CMS with the goal of improving care for California’s seniors and persons with disabilities who are dually eligible for both Medi-Cal and Medicare.
Anthem covers a wide variety of LTSS that help elderly individuals and individuals with disabilities with daily needs such as bathing, dressing, laundry and transportation, improving their quality of life. LTSS are provided over an extended period, predominantly in the homes and communities, but also in facility-based settings such as nursing facilities.
If you are interested in participating with Anthem as an LTSS provider, please send a request with contact information to LTSSProviders@anthem.com.
For full details regarding long-term services and supports and other special programs and pilots, please refer to the Provider Manual .
DHCS has contracted with Anthem to implement the Health Homes Program (HHP) in California. The HHP serves eligible members enrolled in Medi-Cal with complex medical needs and chronic conditions who are frequent utilizers and may benefit from enhanced care management and coordination.
The HHP provides six core services:
To be eligible, members must meet at least one requirement in each section below.
Section 1:
Section 2:
Members must meet at least one of the following acuity/complexity criteria below:Providers can refer members they determine would benefit from HHP services to our Special Programs department for review at CAHealthHomes@anthem.com.
For more information about HHP, including the implementation schedule by county, please visit the Health Homes Program page on the DHCS website.