SB 208 Summary

• Requires the Department of Health Care Services to establish pilot projects in up to 4 counties to develop integrated health care models for individuals eligible for both Medi-Cal and Medicare (dual eligible seniors and persons with disabilities), subject to federal approval and availability of federal funding.

• Permits mandatory enrollment of dual eligible seniors and persons with disabilities into managed care health plans or county alternative models of care through a phased-in process beginning no earlier than February 1, 2011, with various requirements for care coordination, provider networks, and quality monitoring.

• Requires the department to identify health care models by April 1, 2011, develop a timeline and process for implementing pilot projects, and provide these to legislative committees; establishes detailed requirements for managed care plans including risk assessment, medical homes, and care management functions.

• Authorizes the department to establish Coverage Expansion and Enrollment Demonstration (CEED) projects to provide health care benefits to uninsured adults aged 19-64 with incomes up to 200% of federal poverty level, designed to transition enrollees to Medi-Cal or state health insurance exchange coverage by 2014.

• Establishes organized health care delivery models for children eligible for California Children Services (CCS) and allows the Healthy Families Program to permit enrolled children eligible for CCS to participate in these models; requires data submission standards and compliance beginning January 1, 2012.