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A big change is coming to San Benito County Medi-Cal coverage, and if you are already one of the 22,000 people participating in the county program, you might not notice it at all. Starting Jan. 1, Central California Alliance for Health will be taking over coverage and, for the first time, local Medi-Cal recipients will be able to seek treatment outside the county from practitioners in Monterey, Santa Cruz, and Santa Clara Counties.
“This change will make medical care easier for Medi-Cal clients to access,” said Tracy Belton, Director of the San Benito County Health and Human Service Agency. “It will help with everything from walking in a doctor’s door to getting service through their providers.”
County Medi-Cal patients have been previously served under Anthem Health Care and the Medi-Cal Fee-for-Services model through Hazel Hawkins Hospital, four community clinics, and two specialty centers, the San Benito Health Foundation and San Benito Medical Associates.
“We’ve been with Anthem now for some of the medical population for about the last 10 years,” Belton said. “But the separate fees for Anthem and medical services were really confusing to people. Transitioning to the alliance makes it one managed care plan.”
Alliance will provide benefits like check-ups, care management, behavioral health care, wellness programs and a nurse advice line. Residents in underserved areas who are currently going to Salinas for care outside the Anthem plan will be able to receive the same medical services under the Alliance network of providers.
“We’re aware that there are network gaps in San Benito County,” said Central California Alliance for Health Chief Executive Officer Michael Schrader in a June 6 presentation to the San Benito County Board of Supervisors. “So if people are traveling to other cities for care, they’re going to find a really strong and robust Alliance network in Santa Cruz and Monterey counties, including Watsonville and Salinas.”
According to Schrader, the broader scope of treatment options and having a single plan covering many different doctors and services is one of the great benefits Alliance brings.
“Our objective has been to reach out to as many medical providers as meet our criteria,” Schrader said. “So far, we’re pleased with a positive response in their willingness and their interest in contracting with Alliance and seeing medical beneficiaries.”
Enrollment in Alliance will be automatic for residents already enrolled in Medi-Cal, who will receive information packets and new identification cards in the mail shortly before the transition. The only action required is selecting a doctor from the Alliance Provider Directory, which must be done within 30 days of the change. If a patient’s doctor is not on the list, they may be able to continue seeing them through the end of 2024 by contacting Alliance. Any ongoing treatments or appointments with specialists can also continue through 2024. Scheduled surgery appointments will be allowed until June 30, after which a new referral will need to be made.
The Central California Alliance for Health already serves over 420,000 Medi-Cal patients in Merced, Monterey, and Santa Cruz Counties, and has 500 employees in Scotts Valley, Salinas and Merced.
The plan change will particularly benefit lower-income residents who tend to over-use the emergency services at Hazel Hawkins, according to County Supervisor Bea Gonzalez.
“There are so few providers in the community that the chance for many of my constituents to get same-day appointments is nonexistent,” she said. “When people can’t see a doctor, the ER becomes a triage clinic where people go for what would be typical appointments, and this creates many problems for Hazel Hawkins.”
Schrader told the supervisors that Alliance was working with the hospital and hoping to be part of a long-term solution to the hospital’s financial problems by providing more sustainable rates.
“This will be a great benefit for individuals needing professional medical services by greatly expanding the geographic boundaries,” Gonzalez said. “When I first came on as a supervisor, I was made aware of the transition, and I’ve been championing it from the get-go.”
Residents who currently qualify for Medi-Cal but are not enrolled can contact the San Benito County Human Services Agency (831-636-4180) to sign up. Contact Alliance directly at 800-700-3874 Monday through Friday.
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