The Department of Health Care Services (DHCS) transitioned the Child Health and Disability Prevention (CHDP) program to Managed Care Health Plans as of July 1, 2024. This transition is designed to simplify and streamline the delivery of services to children and youth under the age of 21, aligning with the goals of the California Advancing and Innovating Medi-Cal (CalAIM) initiative. This change will bring more efficient and effective healthcare for our young beneficiaries.
The CHDP program includes:
- Programs providing Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) screening, including preventive health, vision, and dental screening, follow-up services, and care coordination
- CHDP Gateway, which serves as a presumptive eligibility entry point for children to receive temporary preventive, primary, and specialty health care coverage through the Medi-Cal Fee-For-Service (FFS) delivery system; and;
- Responsibility for local administration of the Health Care Program for Children in Foster Care (HCPCFC) and the Childhood Lead Poisoning Prevention (CLPP) program.
The transition of the CHDP programs to Managed Care Health Plans will maintain EPSDT services. These services, which are currently mandated to be covered in the Medi-Cal FFS and managed care delivery systems, will continue to be available. Moreover, presumptive eligibility services will persist under the new Children’s Presumptive Eligibility program, ensuring a seamless continuation of care for our young beneficiaries.
At L.A. Care, we are steadfast in our commitment to a streamlined approach for the CHDP program services and the providers who serve our members. We are dedicated to ensuring that the transition is as smooth as possible, and we have detailed the CHDP transition on the CHDP webpage for your reference.
L.A. Care's Transition Plan
Current CHDP: CHDP providers use the CHDP Gateway process to temporarily pre-enroll CHDP-eligible children and youth in fee-for-service, full-scope Medi-Cal. Eligibility is based on age, household composition, and family income.
Transition Plan and Next Steps: The function of the CHDP Gateway has been preserved, expanded, and renamed Childhood Presumptive Eligibility (CPE). The transition to CPE will not impact the general process for enrollment into Medi-Cal from either the provider’s or L.A. Care’s perspective.
DHCS will:
1. Transition the CHDP Gateway to the CPE program
2. Expand access to the CPE program to include all qualified Medi-Cal providers
3. DHCS will develop a Children’s Presumptive Eligibility Program training module (similar to Hospital presumptive eligibility) as part of applicable State requirements for presumptive eligibility qualified entities
4. More information is available at the DHCS CPE website
On July 1, 2024, existing CHDP providers will be transitioned into the presumptive eligibility program and automatically transition into the CPE program.
Current CHDP: Periodic and inter-periodic screenings and assessments are reimbursable for infants and children under 21 years of age, as specified in Bright Recommendations for comprehensive no-cost preventive visits for children, including age and gender-appropriate history, examination, counseling/anticipatory guidance, development surveillance, risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures.
Transition Plan and Next Steps: L.A. Care shall cover and ensure the provision of all screening, preventive, and medically necessary diagnostic and treatment services for Members under 21 years of age required under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services. The EPSDT benefit includes all medically necessary health care, diagnostic services, treatments, and other measures listed in 42 USC Section 1396d(a), whether or not covered under the State Plan.
L.A. Care must adhere to timely access requirements by ensuring network providers offer appointments and make referrals following state guidelines.
Current CHDP: A dental screening/oral assessment is required at every EPSDT/CHDP health assessment, regardless of age. Children and youth should be referred to a dentist.
Transition Plan and Next Steps: L.A. Care shall cover and ensure that dental screenings/oral health assessments for all Members are included in the IHA for Members under 21.
Current CHDP: CHDP providers to adhere to CHDP Health Assessment Guidelines, which support the AAP Brightfuture Periodicity Schedule.
Transition Plan and Next Steps: Bright Futures/AAP is the nationwide standard of practice for all medical providers, including all Medi-Cal providers in all Medi-Cal delivery systems.
L.A. Care provider/PPG contracts require all network providers to comply with these requirements.
Current CHDP: CHDP providers must participate in the Vaccines For Children (VFC) program.
Transition Plan and Next Steps: L.A. Care shall ensure that all children receive necessary immunizations during any health care visit. Providers shall ensure the timely provision of vaccines following the most recent childhood immunization schedule and recommendations published by the Advisory Committee on Immunization Practices (ACIP).
L.A. Care shall provide information to all Network Providers regarding the VFC Program.
Current CHDP: Although statutorily a separate program, local county and city CHDP programs are responsible for administering and overseeing the Health Care Program for Children in Foster Care (HCPCFC). DHCS administers the HCPCFC program at the state level through an interagency agreement with the California Department of Social Services (CDSS).
Transition Plan and Next Steps: DHCS is proposing to establish HCPCFC as a stand-alone program.
DHCS will collaborate with CDSS to amend the existing Interagency Agreement, seek federal approvals, and enact new agreements with counties to verify proper program oversight.
Current CHDP: Providers were responsible for informing patients about the availability of EPSDT/CHDP services and assisting recipients in obtaining the preventive health services for which they were eligible.
Transition Plan and Next Steps: L.A. Care will continue the robust provider trainings, including current CHDP training materials.
L.A. Care will ensure that network providers are able and ready to conduct preventive healthcare services, including EPSDT services such as vision, hearing, fluoride varnish application, and anthropometric screenings.
Current CHDP: Local CHDP programs conduct targeted provider outreach and education activities for the Childhood Lead Poisoning Prevention Program.
Transition Plan and Next Steps: DHCS proposes to continue all existing CLPP Program activities.
L.A. Care is already responsible for conducting blood lead screening for our enrollees. L.A. Care also conducts chart audits as a part of regular Facility Site and Medical Record Reviews (MRRs), which include lead screening reviews and provider training.
L.A. Care will conduct provider training, which includes lead screening training.
L.A. Care is required to provide enrollees with transportation
DHCS is adding lead screening to its yearly performance reporting so that all Health Plans will report this measure for their populations annually.