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
Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan)
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:
- Anthem has a contract with both CMS and DHCS to integrate Medicare and Medi-Cal benefits into one managed care plan called Anthem Blue Cross Cal MediConnect Plan.
- Some dually eligible beneficiaries (those with no share of cost for Medi-Cal or Medicare Parts A and B) may be eligible for Cal MediConnect. They will receive a letter from the state offering Cal MediConnect as an option. Prospective participants can actively enroll, allow passive enrollment into the program, or they can choose to opt out of Cal MediConnect and keep their current plan(s).
- Dually eligible beneficiaries are required to join Medi-Cal to receive their benefits, including long-term services and supports (LTSS) such as in-home support services (IHSS) and long-term care (LTC) custodial facility benefit.
- Santa Clara or Los Angeles counties: If your patients residing in Santa Clara or Los Angeles counties choose to opt out of Cal MediConnect, they will still need to enroll in a Medi-Cal managed care plan. All Medi-Cal services are managed by either Anthem or another local plan in these counties. Dual-eligible members who have no share of cost will be unable to have traditional fee-for-service Medi-Cal in Santa Clara or Los Angeles counties.
For more information about Cal MediConnect, please visit www.calduals.org.
Related resources
- Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) Provider Manual
- Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) (MMP) Model of Care
- Reminder: Hospice Billing Guidelines
- Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) Behavioral Health Provider Orientation
Major Risk Medical Insurance Program (MRMIP)
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.
Medi-Cal Access Program
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.
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:
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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.
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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.
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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.
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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 .
- Long-Term Services and Supports (LTSS) Provider Orientation
- Community-Based Adult Services (CBAS): Provider Orientation for Adult Day Health Care (ADHC) Providers
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.