Anthem Blue Cross

Providers - California

Plan Information


Medi-Cal Managed Care (Medi-Cal)

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.

Related resources

 

Long-Term Services & Supports (LTSS)

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.

In California, LTSS services fall into four categories:

  1. In-Home Support Services (IHSS)

    • IHSS is a federal, state, and locally funded program that provides in-home assistance to low-income adults who are over 65 years of age, blind, or disabled, and to children who are blind or disabled. 
    • Under the CCI, IHSS is a managed care benefit in the eight demonstration counties only, in accordance with existing IHSS statutory and regulatory requirements and guidelines.
  2. Community-Based Adult Services (CBAS)

    • CBAS, formerly known as Adult Day Health Care, is an outpatient, facility-based service program that delivers skilled nursing care, social services, therapies, personal care, family and caregiver training and support, meals, and transportation to the elderly and to younger adults with chronic conditions or disabilities who are at risk of needing institutional care.
  3. Multipurpose Senior Services Program (MSSP)

    • MSSP is a 1915(c) home- and community-based Medi-Cal waiver program that provides care management with the ability to coordinate and/or purchase adult day care, housing assistance, chore and personal care services, protective supervision, respite, transportation, meal services, social services and communication services for Medi-Cal eligible individuals over the age of 65 who meet clinical qualifications for nursing facility admission.
  4. Long-Term Care (LTC)/Skilled Nursing Facility

    • LTC is the provision of medical, social, and personal care services (above the level of room and board) that are not available in the community and are needed regularly due to a mental or physical condition.
    • LTC is generally provided in a facility-based setting such as a skilled nursing facility.

If you are interested in participating with Anthem as an LTSS provider, please send a request with contact information to LTSSProviders@anthem.com

Related resources

For full details regarding long-term services and supports and other special programs and pilots, please refer to the Provider Manual.

 

Health Homes Program for members enrolled in Medi-Cal

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:

  • Comprehensive care management
  • Care coordination (physical health, behavioral health, community-based long-term services and supports)
  • Health promotion
  • Comprehensive transitional care
  • Individual and family support
  • Referral to community and social support services

To be eligible, members must meet at least one requirement in each section below.

Section 1:

  • At least two of the following: chronic obstructive pulmonary disease (COPD), diabetes, traumatic brain injury, chronic or congestive heart failure, coronary artery disease, chronic liver disease, chronic renal (kidney) disease, dementia, substance use disorders
  • Hypertension and at least one of the following: COPD, diabetes, coronary artery disease, chronic or congestive heart failure
  • At least one of the following: major depressive disorder, psychotic disorders (including schizophrenia)
  • Asthma

Section 2:

Members must meet at least one of the following acuity/complexity criteria below:
  • Has at least three or more of the HHP-eligible chronic conditions
  • Has had at least one inpatient hospital stay in the last year
  • Has had three or more ER visits in the last year
  • Has chronic homelessness

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.

Provider tools & resources

Interested in becoming a provider in the Anthem network?

We look forward to working with you to provide quality services to our members.