23-1043 Important Announcement: California Health & Wellness Plan (CHWP) Will No Longer Serve Medi-Cal Members in Certain Counties in 2024
Date: 09/22/23
Effective January 1, 2024, CHWP will cease serving Medi-Cal members in Alpine, Butte, Colusa, El Dorado, Glenn, Mariposa, Nevada, Placer, Plumas, Sierra, Sutter, Tehama, and Yuba counties.
When will members be notified?
Members will receive notification letters from CHWP regarding this change in October 2023. Your patients may come to you as a trusted advisor with questions about their health care coverage. Advise members that they can contact CHWP Member Services at 877-658-0305 (TTY: 711), Monday–Friday, 8 a.m. to 5 p.m.
How does this change impact continuity of care?
If a member has an established relationship with a physician or other provider, even if the physician or other provider is out of network, the new health plan will ensure that members who request continuity of care will receive care for up to 12 months.
Special population members (individuals living with complex or chronic conditions) who receive specific benefits, such as transplant care, inpatient services and end-of-life care, including transitioning members who are currently receiving care management services from CHWP, will transition to a new care manager on January 1, 2024, when they switch their new Medi-Cal plan. The newly assigned care manager from the new plan will reach out directly to these members shortly after their transition to the new plan.
This important information will be shared in notification letters scheduled to be sent to members in October 2023. Member letters will include continuity of care benefit details and information regarding the required steps members must take to request continuity of care.
For additional information, refer to the Department of Health Care Services (DHCS) 2024 Medi-Cal Managed Care Plan Transition Policy Guide (PDF).
What happens to existing prior authorizations?
The new Medi-Cal plan is required to honor all existing 2023 prior authorizations for 2024 services, both in network and out of network, at the time of transition. Physicians and providers do not need to obtain new prior authorizations if they are already in place.
How long will I have to submit claims to CHWP?
Physicians and providers who have rendered services to CHWP members residing in these counties in 2023 will have 180 days from the date of service to submit their claims to CHWP. Your Participating Provider Agreement (PPA) will remain in place however and is not affected by this member transition.
How are appeals, grievances and disputes addressed?
Topic | Prior to January 1, 2024 | After January 1, 2024 |
|---|---|---|
Appeals and Grievances | Phone: 877-658-0305 | Submit to the new Medi-Cal plan |
Dispute and appeals | California Health & Wellness Plan Phone: 877-658-0305 | Submit to the new Medi-Cal plan |
How does this change impact future facility site and medical records reviews?
Starting January 1, 2024, the new Medi-Cal plan will assume responsibility for reviewing primary care physicians' Medi-Cal facility sites and medical records.
Provider portal and website access
You can continue to access the CHWP portal, as well as the public provider website for historical information as needed until further notice.
Don't miss out on upcoming office hours so you can get answers to your important questions!
Stay informed and get all your questions answered by attending our upcoming office hours. Don't miss out on this valuable opportunity to get the answers you need.
Date | Time | Registration |
|---|---|---|
Wednesday, November 15, 2023 | Noon (12 p.m.) to 1:30 p.m. |
To register, follow these steps:
- Select the registration URL.
- Fill in the required information to register.
- Add the webinar to your calendar.
Additional information
If you have questions regarding this transition, contact CHWP at 877-658-0305 or visit the following websites for additional information.
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This information applies to Physicians, Independent Practice Associations (IPAs), Hospitals, Ancillary providers, Community Supports (CS) Providers, and Enhanced Care Management (ECM) Providers.